To explore the role of application of Radium-223(Ra-223) to treat prostate cancer (PCa) from the documented clinical practice guidelines (CPGs) between China, Japan and Taiwan.

The printed / online materials in guidelines for PCa from China, Japan and Taiwan were analyzed. We focused on the Ra-223 treatment for PCa.

The online and updated guidelines for PCa were reviewed. Chinese online version by the National Health Commission of the People's Republic of China (NHCPRC version 2022), and the Chinese Society of Clinical Oncology (CSCO version 2023). Japanese printed version by the Japanese Urological Association (JUA) was a version of 2023(2006 as the first version). Taiwanese first version was available by the Taiwan Cooperation Oncology Group (TCOG) PCa practice guidelines in 1999 through 2010, and Taiwanese Urological Association with version of 2024. Normal range of prostate specific antigen (PSA) is defined from native people data with age specific consideration in NPCPRC, CSCO, and JUA but not in TCOG and TUA. PCa Staging with American Joint Committee on Cancer (AJCC,) was noted but not clearly mentioned in JUA, but clearly mentioned by AJCC (2010) in TCOG and AJCC (8th ed., 2017) in NHCPRC, CSCO and TUA. In defining metastatic castration resistant PCa (mCRPC), not clearly defined only in TUA. The application of RA-223 was well discussed with clinical questions section in JUA which including symptomatic skeletal events and survival benefits. Ra-223 was applied as the second line for mCRPC and mentioning the fundamental effects with safety issues in NPCPRC and CSCO. Ra-223 was passed for reimbursement by the National Insurance of Health of Taiwan in March 2019, but still not well discussed in Taiwanese TUA CPG.

There are differences in roles of Ra-223 treatment for mCRPC among the CPGs. From views of evidence-based medicine (EBM), updating and revision of Taiwanese CPG for PCa is suggested.