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Opinion|Videos|May 13, 2026

Alpha-Emitting Therapies in Metastatic Castration-Resistant Prostate Cancer

Author(s)Pedro C. Barata, MD, MSc, FACP , Johann de Bono, MD, PhD

Dr. Johann De Bono and Dr. Pedro Barata discuss the evolving role of alpha-emitting radiopharmaceutical therapies in metastatic castration-resistant prostate cancer (mCRPC), with a focus on radium Ra 223 dichloride and recent data from the PEACE III trial.

Episodes in this series

EP. 1 Radiopharmaceutical Strategies in Metastatic Castration-Resistant Prostate Cancer

EP. 1 Radiopharmaceutical Strategies in Metastatic Castration-Resistant Prostate Cancer

EP. 2 Combination Radiopharmaceutical Approaches in Metastatic Castration-Resistant Prostate Cancer

EP. 2 Combination Radiopharmaceutical Approaches in Metastatic Castration-Resistant Prostate Cancer

EP. 3 Alpha-Emitting Therapies in Metastatic Castration-Resistant Prostate Cancer

EP. 3 Alpha-Emitting Therapies in Metastatic Castration-Resistant Prostate Cancer

EP. 4 Patient Selection for Radiopharmaceuticals in Metastatic Castration-Resistant Prostate Cancer

EP. 4 Patient Selection for Radiopharmaceuticals in Metastatic Castration-Resistant Prostate Cancer

EP. 5 Treatment Sequencing in Metastatic Castration-Resistant Prostate Cancer

EP. 5 Treatment Sequencing in Metastatic Castration-Resistant Prostate Cancer

EP. 6 Combination and Sequencing Strategies in Metastatic Castration-Resistant Prostate Cancer

EP. 6 Combination and Sequencing Strategies in Metastatic Castration-Resistant Prostate Cancer

EP. 7 Safety and Toxicity Management in Metastatic Castration-Resistant Prostate Cancer

EP. 7 Safety and Toxicity Management in Metastatic Castration-Resistant Prostate Cancer

EP. 8 Future Radiopharmaceutical Strategies in Metastatic Castration-Resistant Prostate Cancer

EP. 8 Future Radiopharmaceutical Strategies in Metastatic Castration-Resistant Prostate Cancer

EP. 9 Personalized Treatment Decision-Making in Metastatic Castration-Resistant Prostate Cancer

EP. 9 Personalized Treatment Decision-Making in Metastatic Castration-Resistant Prostate Cancer

EP. 10 Future Directions in Metastatic Castration-Resistant Prostate Cancer

EP. 10 Future Directions in Metastatic Castration-Resistant Prostate Cancer

Dr. Johann De Bono and Dr. Pedro Barata discuss the evolving role of alpha-emitting radiopharmaceutical therapies in metastatic castration-resistant prostate cancer (mCRPC), with a focus on radium Ra 223 dichloride and recent data from the PEACE III trial. Dr. Barata reviews the historical development of radium Ra 223 dichloride, highlighting its demonstrated overall survival benefit, favorable tolerability profile, and the importance of earlier use in the disease course. The discussion also explores how contemporary treatment paradigms and newer radioligand therapies are reshaping the positioning of radiopharmaceuticals in mCRPC. Dr. Barata emphasizes the clinical significance of the PEACE III data evaluating radium Ra 223 dichloride in combination with enzalutamide, including improvements in radiographic progression-free survival and overall survival outcomes. In addition, the faculty discuss the critical role of bone-modifying agents in reducing skeletal-related events and fracture risk, while considering how established alpha-emitting therapies may continue to fit within the future treatment landscape of mCRPC.

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