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This is a combination therapy comprising **radium-223 dichloride**, a radiopharmaceutical that selectively targets bone metastases by mimicking calcium and binding to areas of increased bone turnover, and **hormonal therapy** agents, mainly androgen deprivation therapies (ADT), anti-androgens, or androgen synthesis inhibitors. Radium-223 dichloride emits high-energy alpha particles that cause double-strand DNA breaks in adjacent cancer cells, primarily used for **castration-resistant prostate cancer** (CRPC) with symptomatic bone metastases and no visceral metastases. Hormonal therapy in this combination aims to suppress androgen signaling, which is the main driver of prostate cancer growth. The combination may also be considered in other hormone-sensitive cancers with bone metastases, although evidence and approval status are clearest in the prostate cancer setting. Combination therapy may pose additional safety considerations; for instance, increased risk of fractures and mortality has been observed when radium-223 dichloride is combined specifically with abiraterone plus prednisone/prednisolone[4].
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