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Radium-223 dichloride (Ra-223) is an alpha particle-emitting radiopharmaceutical whose licensed indication in patients with castration-resistant prostate cancer with bone metastases (CRPCm) was modified in June 2018, due to the appearance of drug-drug interactions with common drugs in CRPCm such as abiraterone and prednisone/prednisolone. Thus, it was restricted to use in monotherapy or combination with luteinizing hormone-releasing hormone analogues, becoming third-line treatment in patients with CRPCm, for which evidence on its effectiveness and safety in this new context is lacking.