While our radium-223 study was not powered to detect clinical differences according to osteomimicry genomic alterations, our study is the first to report on genomic alterations in key osteoblast regulators including ALPL itself in 25% of men with prostate cancer, and supports these prior mechanistic phenotypic studies of ALPL in bone metastases and outcomes. This evidence concerns the gene ALPL and Familial prostate cancer.