Prostate-Specific Membrane Antigen-Ligand Therapy What the Radiologist Needs to Know

In an era in which more and more patients with PCa are treated with multiple agents in the up-front metastatic setting, orthogonal therapies that leverage new targets via novel mechanisms are necessary. PRLT is one such approach, whereby the near universal expression of PSMA is used to deliver cytotoxic levels of radiation to the PCa cells. This approach requires specialized personnel and careful selection of patients to optimize efficacy while limiting toxicity. Although PRLT with Lu-177-labeled agents is already an accepted standard-of-care for men with mCRPC who have previously been treated with chemotherapy, there remains a tremendous amount to learn. Eventually, new therapeutic agents will coalesce with improved nomograms and patient-selection algorithms, as well as AI, to maximally benefit patients.