Comment on: 'Impact of DNA damage repair defects on response to radium-223 and overall survival in metastatic castration-resistant prostate cancer' by De Vincentis et al

223Radium-dichloride (223Ra) is the first osteotropic radiopharmaceutical capable of increasing survival in patients with metastatic castration resistant prostate cancer (mCRPC) unlike beta-emitting radiopharmaceuticals previously only used for pain relief. It is generally accepted that this capacity lies in the peculiar characteristics of 223Ra, the first alpha emitter radioisotope approved for clinical use. Bone absorbed doses per disintegration from alpha particles of 223Ra is approximately 24 times higher than absorbed doses from beta particles of 89Strontium-chloride. This feature allows the delivery of an intense and highly localised dose to the bone with sparing the bone marrow in comparison with the beta emitter radiopharmaceuticals.