I was confronted with a decision in the clinic this week about whether or not to use radium-223 for a patient with metastatic castration-resistant prostate cancer (mCRPC). He was on the older side, mid to late 80’s and his performance status was declining rapidly. He had persisted for quite some time with relatively low volume disease, in fact, just pelvic lymph nodes. As those progressed, he developed urinary outlet obstruction (even though the nodes weren’t that big) with multiple urinary tract infections (UTI) and, during a several month period marked by brief hospitalizations, relatively rapid failure of next-generation androgen receptor (AR) antagonists, all amidst the COVID-19 (SARS-CoV-2) pandemic, metastatic disease in the bone blossomed in multiple sites, and it was associated with relatively mild pain.