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Introduction: Prostate cancer is the second cause of cancer-related death. The treatment for metastatic disease with bone activity is multimodal and includes external beam radiation therapy and radiopharmaceuticals with bone affinity. The therapeutic decision is based on the presence or absence of symptoms, on prostate-specific antigen behavior, and on the distribution of metastatic disease, where the role of chemotherapy is well defined (presence or absence of visceral metastases or only bone disease). Radium-223 dichloride (223-Ra) is a calcium-mimetic radiopharmaceutical with activity in osteoblastic lesions that has demonstrated an increase in the time to first skeletal symptomatic event, a decrease in alkaline phosphatase and increased quality of life, with good tolerance. Case presentation: An 83-year old male diagnosed in 2011 with prostate adenocarcinoma with bone metastases, treated with hormone blockade for two years. In 2013, he developed hormone-refractory disease progression at the bone level, which was treated with abiraterone in 2014, with prostate-specific antigen elevation and bone pain due to bone progression without visceral disease. In January 2015, radium-223 was indicated every 28 days for four cycles, with important symptom improvement and adequate toxicity profile. Conclusions: Treatment with radium-223 provides adequate pain control with an important decrease of alkaline phosphatase and quality of life improvement, offering yet another alternative for patients with castration-resistant metastatic prostate cancer and symptomatic bone disease, with an acceptable toxicity profile. (creativecommons.org/licenses/by-nc-nd/4.0/). CLINICAL CASE Treatment with Radium 223 in a Patient with Castration-Resistant Metastatic Prostate Cancer: A Case Report Christian Patricio Camacho-Limas*, Alberto Villalobos-Prieto and Raquel Gerson-Cwilich Department of Medical Oncology, American-British Cowdray Medical Center, Mexico City, Mexico Received for publication: 30 June 2016; accepted for publication: 25 February 2017 Available online: 14 July 2017