@digger: Thanks Colleen for bringing me in for this discussion. I began my radium223 treatments in November 2021. I ultimately had five of six projected treatments. Prior to and during the radium223 treatment I was on enzalutimide, having used bicalutimide first. I also had eligard injections every six months since March 2019 and zolodronic acid infusions every three months since early 2019. I had 44 radiation treatments in 2019. My PSA varied from a start of 541 got down to 2.2 during radiation (perhaps a false reading) and then began to rise again. Frankly I have lost track of when it rose and when it hit a high of 1131.
The radium223 treatment had very positive impact on the cancer but with the significant side effects of low blood counts. During treatment I received several blood and platelet transfusions. A blood marrow biopsy in February 2022 resulted in a decision to go to a docetaxel chemo treatment. The blood count side effects continued throughout the chemo treatment. We did five of six treatments and then we stopped that treatment. Since then (about May of this year) my PSA went up to 1013 or so. Now we are looking for the next step. I had a PSMA PET with F18 isotope yesterday. And will get the results on Monday. One option on the table is Lu177 treatment but time will tell.
So, as for the impact of the Radium223, I would say it helped hold the cancer in check but with the side effect of compromised blood counts at all levels. Hemoglobin, white cells,
neutrophiles,, and platelets.
As you begin this treatment please keep a close eye on your counts. Don't let them get out of hand. I think this is a good treatment but, in my case, the side effects were significant.
I hope this long-winded response is helpful to some degree. In so far as possible, stay positive and stay patient. This is a long journey but all we can do is educate ourselves as best possible and stay involved in our treatment plan. Ask questions, get answers and keep pushing forward. If radium223 does not work. Look for something else. There are many options. Keep looking for the next step.

Good luck