If you have metastatic prostate cancer, your cancer has spread beyond the prostate to other areas, which may include the lymph nodes, bones, lungs, and liver. Depending on several factors that should be discussed with your prostate cancer team, you may be a candidate for PSMA radioligand therapy. PSMA radioligand therapy is a type of targeted radiation treatment, using a medicine that finds prostate cancer cells and sends radiation directly to them.
What Is PSMA?
Prostate-specific membrane antigen (PSMA) is a protein found on the surface of prostate cancer cells. Your prostate cancer team can use a special imaging test called a PSMA PET/CT scan to look for this protein. During the scan, a small amount of a radioactive substance called a radiotracer is injected into a vein. The radiotracer attaches to PSMA on prostate cancer cells, and the PSMA PET/CT scan can then show where prostate cancer is located in the body.
If your scan shows that your prostate cancer has enough PSMA on its surface (it is “PSMA positive”), you may be a candidate for PSMA radioligand therapy.
How Does PSMA Radioligand Therapy Work?
PSMA radioligand therapy uses a molecule that is designed to find and attach to PSMA on prostate cancer cells. The molecule is linked to a radioactive substance called Lutetium-177.
When the treatment attaches to a prostate cancer cell, the Lutetium-177 releases radiation that damages and kills the cancer cell. The radiation travels only a very short distance – about 1 millimeter, helping to limit the amount of radiation reaching nearby healthy cells.
Lutetium-177 PSMA radioligand therapy (also known as Pluvicto) is currently the FDA-approved PSMA-targeted radioligand therapy.
Is Lutetium-177 PSMA Radioligand Therapy Right for Me?
As of 2026, there are three important clinical settings in which prostate cancer patients may receive Lutetium-177 PSMA radioligand therapy:
- Metastatic androgen pathway modulation-naïve or sensitive (APMN/S) prostate cancer. As of July 2026, Lutetium-177 PSMA radioligand therapy is now FDA approved in combination with an androgen receptor pathway inhibitor (ARPI) for patients with PSMA-positive metastatic prostate cancer that is still sensitive to hormone therapy. This recent approval was based on the PSMAddition trial.
- Metastatic androgen pathway modulator-resistant (APMR) prostate cancer (the cancer is still growing, despite hormone therapy) before chemotherapy. For patients whose cancer has progressed despite hormone therapy and treatment with an ARPI, Lutetium-177 PSMA radioligand therapy may be used before chemotherapy when the patient and care team believe delaying chemotherapy is appropriate. This expanded indication was based on the PSMAfore trial in March 2025.
- Metastatic APMR after chemotherapy. Lutetium-177 PSMA radioligand therapy may also be used later in the prostate cancer journey for patients who have previously received an ARPI and chemotherapy, based on the VISION trial that led to the original FDA approval (March 2022).
Importantly, eligibility is not determined by disease stage alone. A PSMA PET scan is used to confirm that the cancer has sufficient PSMA expression, and the care team considers previous treatments, symptoms, other medical conditions, laboratory results, and individual treatment goals when deciding whether Lutetium-177 PSMA radioligand therapy is appropriate.
What Are Possible Side Effects?
Lutetium-177 PSMA radioligand therapy can have side effects, which may include:
- Tiredness
- Nausea
- Dry mouth
- Dry eyes
- Loss of appetite
- Vomiting
- Low red blood cell count (anemia)
- Low platelet count
- Increased risk of infection
- Reduced kidney function
Because the treatment uses radiation, there may also be a small long-term risk of developing another cancer.
What Can I Expect During Treatment?
Lutetium-177 PSMA radioligand therapy is given through an intravenous (IV) infusion, typically in a specialized treatment center. Before each treatment, your care team will check blood tests to make sure your blood counts, kidney function, and other laboratory values are ok to receive treatment. The treatment itself is generally straightforward and does not usually require an overnight hospital stay. For most patients, Lutetium-177 PSMA radioligand therapy is typically given once every six weeks, for up to six treatments. Your care team will also monitor you for side effects, as discussed above. Blood tests and imaging are usually performed during treatment to assess how you are tolerating therapy and how the prostate cancer is responding.
Radiation Safety After Treatment
Because Lutetium-177 PSMA therapy uses a radioactive medication, a small amount of radiation remains in your body for a short time after each treatment. Most patients can return home the same day, but your treatment team will provide radiation-safety instructions to follow at home. These may include temporarily limiting close or prolonged contact with other people, particularly children and pregnant individuals, sleeping separately from a partner, and taking extra care with bathroom hygiene. You may also be encouraged to drink plenty of fluids and urinate frequently to help remove the medication from your body. The specific precautions and how long they are needed can vary, so it is important to follow the instructions provided by your treatment center. These precautions are temporary and are designed to minimize unnecessary radiation exposure to family members and others.
Is PSMA Radioligand Therapy Right for Me?
PSMA radioligand therapy may be an option for some men with advanced prostate cancer that is “PSMA positive”. Your healthcare team will consider:
- The type and stage of your prostate cancer
- Which treatments you have already had
- The results of your PSMA PET/CT scan
- Your overall health
- Your kidney and blood cell function
If you are interested in PSMA radioligand therapy, ask your prostate cancer doctor if you may be a candidate. Treatment discussions should include all possible options, including Lutetium-177 PSMA radioligand therapy.