Prostate cancer (PC) is the most common neoplasm in men in Western countries, and approximately 10 -20 % of patients with PC will develop castration-resistant disease (CRPC) [1]. More than 90 % of men with metastatic CRPC have radiological evidence of bone metastases, which are a major cause of decreased quality of life, morbidity, treatment costs and mortality [2]. CRPC is considered an incurable condition, with a median survival of less than 2 years [3].Nuclear medicine has been profoundly involved in the management of PC patients, particularly for those with metastatic disease. First, there has been increasing interest in some radiopharmaceutical agents able to specifically target the bone or the cancer, and second a new therapeutic radiation-based strategy able to provide survival advantages beyond palliative effects has recently been introduced. These Bnew^options open the door to a multidisciplinary approach involving strong cooperation between nuclear medicine physicians and other specialists including oncologists, radiation oncologists and urologists, that will allow the development and implementation of diagnostic and therapeutic strategies in patients with PC. This is the most efficient way to guarantee that professionals and structures are available to offer care at all stages to patients with PC, taking into account both the optimized current strategies and futures updates and modifications [4].Until a few years ago, the therapeutic instruments of nuclear medicine in the management of PC consisted of some betaemitting agents for the treatment of bone metastases, such as Ra-dichloride (Xofigo®) is the first targeted α-emitting radiopharmaceutical agent approved for the treatment of patients with metastatic CRPC that has been shown to improve overall survival, and also to delay skeletal-related events (SREs) and better control of bone pain. It selectively binds to areas of increased bone turnover, thus producing nonrepairable double-stranded DNA breaks [5,6], with a potent cytotoxic effect [7][8][9]. 223 Ra has a relatively low haematological toxicity profile compared with β emitters [5,10]. The short range of α particles (100 μm, less than ten cell diameters) and the high linear energy transfer (27.4 MeV) produce a strong effect in a restricted area, limiting damage to adjacent tissues [10]. After injection, Ra [13] and no dose modification is required in elderly or unfit patients.The overall survival benefit and safety profile of 223 Ra have been documented in the phase III ALSYMPCA trial, a randomized, double-blind, placebo-controlled, multinational study comparing the efficacy and safety of 223 Ra plus best standard of care with placebo plus best standard of care in CRPC patients with symptomatic bone metastases (two or more) and no evidence of visceral disease [8,14]. A total of 921 patients were enrolled, distributed in two arms ( 223 Ra,