Radioligand Therapy for Prostate Cancer - A Clinical Consultation Guide

Prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT) is now an established treatment for metastatic castration-resistant prostate cancer (mCRPC), demonstrating improved oncologic outcomes and incorporation into international guidelines. Landmark trials including VISION, TheraP, and PSMAfore have defined the efficacy, safety, and clinical role of [¹⁷⁷Lu] Lu-PSMA-617, showing improvements in survival, progression-free survival, and biochemical response rates. Appropriate patient selection remains critical, relying on PSMA positron emission tomography imaging, disease burden assessment, and multidisciplinary evaluation. Emerging imaging biomarkers may further refine selection but remain investigational. Beyond heavily pretreated mCRPC, evidence is expanding for earlier use in taxane-naïve disease, metastatic hormone-sensitive prostate cancer, and neoadjuvant settings. This Clinical Consultation Guide summarises contemporary evidence, practical treatment considerations, toxicity monitoring, and future directions for integrating PSMA-RLT into prostate cancer management.