Soares De Pinho, InêsEsperança Martins, MiguelMachado, BárbaraDâmaso, SaraBrás, RaquelCantinho, GuilherminaFernandes, IsabelCosta, Luis2024-11-192024-11-192024Cureus. 2024 Feb 5;16(2):e53637http://hdl.handle.net/10400.5/95443© Copyright 2024 Soares de Pinho et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are creditedRadium-223 dichloride (Ra223) is the first targeted alpha agent approved for treating metastatic castration-resistant prostate cancer (mCRPC) with bone-exclusive disease. A benefit in overall survival and time to the first symptomatic skeletal-related event was shown in the Alpharadin in Symptomatic Prostate Cancer Patients (ALSYMPCA) trial. However, this trial did not describe a bone scan response to Ra223, and there is no universal consensus about how it should be monitored. Furthermore, a scintigraphy flare phenomenon may lead to false-positive tracer uptake in responsive cases, thereby misleading the interpretation of imaging results. We present the case of a 67-year-old male with mCRPC and exclusive bone disease treated with Ra223. The bone scintigraphy after the end of the treatment showed an apparent aggravation of the lesions, corresponding to a flare phenomenon, with an almost complete resolution after three months. The patient maintained a scintigraphic response for seven months.engBone diseaseFlareProstate cancerRadium-223Responsejournal article10.7759/cureus.536372168-8184