Lutetium-177 PSMA radioligand therapy (RLT) represents a paradigm shift in advanced prostate cancer care, establishing a precision oncology standard through its inherent theranostic capability. From a nuclear medicine perspective, its defining success lies in the ability to precisely select patients and offer targeted cytotoxic delivery of radiation, resulting in high objective response rates and quality-of-life improvements, particularly rapid pain palliation. A collaborative view with medical oncology highlights critical limitations. Despite frequent favourable initial responses, disease recurrence is almost universally inevitable, demonstrating a modest survival benefit in randomised trials and possibly limited control over micrometastatic or heterogeneous disease. The future requires bridging this gap through interdisciplinary research: leveraging molecular imaging for adaptive treatment strategies, evaluating earlier-line use, and developing synergistic combinations and next-generation isotopes, including Auger/conversion electron and alpha emitters, to maximise clinical benefit and achieve durable responses.
European urology focus. 2026 May 29 [Epub ahead of print]
Michael S Hofman
Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia; Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. Electronic address: .