Practical Clinical Consultation Guide to Radioligand Therapy in Prostate Cancer

Prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT) with 177-Lutetium-PSMA has significantly improved outcomes in advanced prostate cancer; however, optimising its clinical application requires a nuanced, individualised approach. This review outlines key principles for patient selection, therapeutic monitoring, and adaptive dosing strategies to maximise efficacy while limiting toxicity. Adaptive strategies, including dose escalation or fractionation informed by tumour volume, treatment pauces at exceptional response, and retreatment at relapse, offer opportunities to personalise and optimise therapy beyond the standard six-cycle regimen.Additionally, defining clinical, imaging, and molecular biomarkers for resistance and efficacy will improve patient selection and clinical outcomes. As novel radioisotopes and combination strategies emerge, optimising treatment approaches will be essential to realise the full potential of RLT in prostate cancer.