Information leaflet on Radium 223 (Ra223) for the treatment of bone metastases from prostate cancer
This leaflet provides information on molecular radiotherapy treatment for bone metastases with Radium 223. This is an effective radioactive treatment for those with multiple bone metastases from prostate cancer.
Your oncologist will refer you to the Radium 223 treatment team if they feel this is the right therapy for you. You will be sent an appointment to meet the team and discuss this further. After meeting they will confirm that you are suitable to have Radium 223.
The treatment usually takes 30 minutes to be given and is given in a dedicated room in Velindre. It is not available in other outreach centres. Treatment is given approximately every 28 days, on either the 2nd or 4th Thursday of the month. Depending on how you respond and tolerate the treatment, we would aim to give a total of six injections over a six month period. This leaflet will describe the treatment, possible side effects and the precautions that we would like you to follow after your treatment.
What is Radium 223 and when is it used?
Men with prostate cancer may develop bone metastases which can become painful. If your current treatment becomes less effective, your doctor may recommend molecular radiotherapy treatment. Radium 223 is a radio-isotope that behaves like calcium in your body. It is absorbed by the bones after being injected into a vein. Once in the bone, the radium delivers radiotherapy directly to the site of bone metastases. It should help to give relief from pain and has been shown to control the cancer. It is sometimes used with bone strengthening medications.
Preparation for treatment
About 7-10 days before each treatment, you will have an appointment in Velindre for a pre-treatment assessment. At this visit you will be asked some questions about your health, have a blood sample taken, and you will be weighed. We will discuss each time the precautions you need to take whilst on this treatment.
On the day of treatment
On arrival, you will report to the Nuclear Medicine department on the main corridor in the hospital. You may bring someone with you to the hospital but they will need to wait in the waiting room whilst you have treatment.
For treatment, a small needle or cannula will be placed in the back of your hand or arm. Radium is a clear liquid which is injected over a short number of minutes. The needle or cannula will be removed before you leave. You can leave the hospital straight after the injection has been given. You can expect to feel well.
You will be given a small card to carry at all times for one week after treatment. The card will state what treatment you have received and the telephone number for the treatment helpline in the event of any problems.
What are the side effects of Radium 223?
Radium can affect your blood cell counts. This may lead to symptoms such as fatigue, unusual bruising, or more bleeding than usual after an injury. You may have an increased risk of infection. It is important that if you are feeling unwell after treatment you contact the treatment helpline. The telephone number is at the end of the leaflet.
Please contact the treatment helpline if you have a temperature of 37.5 degrees or more immediately.
Patients may occasionally have sickness or diarrhoea for a short period after treatment. Ensure that you drink plenty to remain hydrated. If you vomit or have more than 4 loose motions in 24 hours, contact the treatment helpline.
Radium is absorbed into the areas of the bone metastases. This can sometimes cause pain to worsen about 24 hours following the injection. This may last for about 48 hours. You may need to take extra painkillers if necessary for this short period. This will be discussed in your clinic appointment.
Radium may affect your jaw bone and teeth. This is an uncommon side effect. Before having dental treatment, please make your dentist is aware.
Are there any restrictions on what I can and can’t do after radium treatment?
There are no restrictions on normal contact with other people immediately after treatment. You will not be harmful to others including children and pregnant women.
During the first week after treatment, there may be some radioactivity in your body fluids, particularly your urine and stools. These levels are likely to be low.
Precautions
For the first seven days following treatment we would like you to do the following:
Carry your treatment card with you at all times.
When passing urine, please sit on the toilet rather than using a urinal. The toilet should be flushed twice. Always wash your hands thoroughly.
If any body fluids need to be handled, particularly urine or stools, please use rubber gloves (we can provide these if necessary). If tissues are used, flush the tissues away immediately. Wash any soiled bedding or clothes immediately and separately from other items. Please use detergent and a hot wash setting.
You should avoid having any blood, urine or stool tests for the first week after treatment. It is absolutely necessary please contact the treatment helpline who can put you through to the relevant team to advise.
If you use a catheter, please let the team know before any treatment starts. We will give you further advice about management.
If you are sexually active, please use a condom during treatment as small amounts of radioactivity may be present in bodily fluids. You should also avoid fathering a pregnancy for six months after completing treatment.
If you die within four weeks of treatment, our radiation protection team may need to speak to the relevant people who may care for your body. It is important that your family are aware that you are having this treatment so they can update the hospital in the event of a death. It is unlikely that there will be any delays to further proceedings.
Contact telephone numbers
Velindre Cancer Centre 029 2061 5888
Ask for the treatment helpline if you are unwell at home and need immediate advice at any time of the day or night. For example you should phone if you:
· Are sick more than once in 24 hours
· Have a temperature of 37.5°C or above
· Have diarrhoea
Tenovus freephone 0808 808 1010
cancer helpline
7 days a week 8am – 8pm for general queries on cancer
This leaflet was written by health professionals. The information contained in this leaflet is evidence based. It has been approved by doctors, nurses and patients. It is reviewed and updated every 2 years.
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Prepared March 2019 Reviewed March 2019 |