Neal Shore, MD, FACS of the Carolina Urologic Research Center, Myrtle Beach, SC talks about bone-migrated prostate cancer and Radium-223 therapy. Dr Shore explains that the concept of the bone migratory pathway is very contemporary and he further discusses the bone microenvironment and its importance in prostate cancer. He points out that 90% of patients who die with castration-resistant prostate cancer will have bone metastases. In the symposium, they reviewed imaging and the data from the recent ALSYMPCA trial (NCT00699751), which demonstrated the survival advantage of giving Radium-223. Radium-223 is a novel radiopharmaceutical. Dr Shore explains that it is different from the historical beta/gamma particles, which are much smaller. He explains that there is less penetration into the marrow and less myelosuppression. He highlights that Radium-223 prolongs survival first and foremost. Further, the therapy is well-tolerated. When he started using the therapy, it was mostly after chemotherapy and now, 90% of his patients receive it before chemotherapy. Moreover, he highlights the three Ps and their importance in his clinic: prolonged life, preserve function, prevent complications of therapy. Recorded at the 2016 annual meeting of the European Society of Medical Oncology (ESMO), held in Copenhagen, Denmark.