RLT Platform

Radioligand Therapy (Prostate) — Overview

High-level, prostate-focused overview of radioligand options and evidence notes. Pluvicto® is the regulatory anchor; other agents are included for landscape context.

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[177Lu]Lu-PSMA-617 (Pluvicto®)

Emitter: β

Status: FDA/EMA approved

Where it fits: mCRPC; post ARPI + taxane (per label/trials)

Toxicity signal: xerostomia; cytopenias

Evidence notes
  • VISION reported OS/PFS benefit vs SOC in PSMA-positive mCRPC (see primary publication).
  • Monitor per institutional protocol.
Dosimetry (optional)
Lu-177 decay scheme (schematic)

[177Lu]Lu-PSMA-I&T

Emitter: β

Status: Clinical use / trials (region-dependent)

Where it fits: PSMA-targeted alternative ligand

Toxicity signal: xerostomia; cytopenias

Evidence notes
  • Comparative statements depend on population, imaging criteria, and trial design.

[225Ac]Ac-PSMA-617

Emitter: α

Status: Investigational / compassionate use

Where it fits: post-Lu progression (investigational); high-burden scenarios (series-level)

Toxicity signal: xerostomia (often more severe); cytopenias

Evidence notes
  • Reported PSA responses in small series; interpret cautiously (selection bias; heterogeneous dosing).
  • Xerostomia signal is prominent across published reports.
Investigational
Ac-225 decay scheme (schematic)

Ra-223 (Xofigo®)

Emitter: α

Status: FDA approved

Where it fits: symptomatic bone mets; no known visceral disease (per indication)

Toxicity signal: myelosuppression / thrombocytopenia

Evidence notes
  • ALSYMPCA reported OS benefit and SSE delay in appropriate patients (see primary publication).
Bone-only indication
Ra-223 decay scheme (schematic)

[131I]I-PSMA (MIP-1095 / I-PSMA-1095)

Emitter: β/γ

Status: Trials

Where it fits: PSMA-targeted (trial setting)

Toxicity signal: hematologic toxicity signal

J591 (PSMA monoclonal antibody, radio-labeled)

Status: Trials

Note: Antibody PK may shift marrow exposure; interpret within trial context.

Toxicity signal: marrow toxicity signal

Emerging PSMA ligands (albumin-binding, novel scaffolds)

Status: Early clinical / preclinical

Goal: PK engineering to alter tumor uptake / residence time

Toxicity: construct-dependent

Agent Emitter Status Where it fits (tags) Key toxicity signal
[177Lu]Lu-PSMA-617 (Pluvicto®)βFDA/EMA approvedmCRPC; post ARPI + taxaneXerostomia; cytopenias
[177Lu]Lu-PSMA-I&TβClinical use / trialsPSMA-targeted alternative ligandXerostomia; cytopenias
[225Ac]Ac-PSMA-617αInvestigationalpost-Lu progression (series-level)Xerostomia; cytopenias
Ra-223 (Xofigo®)αFDA approvedBone mets; no known visceral diseaseThrombocytopenia
[131I]I-PSMA (MIP-1095)β/γTrialsPSMA-targeted (trial setting)Hematologic toxicity
J591 (radio-labeled)variesTrialsAntibody-based targetingMarrow toxicity

This comparison is intentionally high-level and non-prescriptive.

Before considering PSMA-targeted RLT
  • Confirm PSMA expression with appropriate imaging (document criteria used).
  • Baseline marrow reserve (CBC) and prior marrow-toxic therapies.
  • Renal function context (document baseline and monitoring plan).
  • Discuss xerostomia risk (especially for alpha-emitter pathways).
  • Clarify disease context and prior lines of therapy (for trial/label alignment).
Before considering Ra-223
  • Bone-metastatic context and absence of known visceral disease (per indication).
  • Marrow reserve and concurrent therapies that increase cytopenia risk.
  • Define goals of therapy and monitoring plan for symptomatic skeletal events.

These are workflow reminders, not prescribing rules.

NuDat (NNDC, Brookhaven)

NuDat is a web application that allows users to search and plot nuclear structure and nuclear decay data interactively. It was developed by the National Nuclear Data Center (NNDC) at Brookhaven National Laboratory.

Open NuDat

References

  • Sartor O, et al. Lu-PSMA-617 for metastatic castration-resistant prostate cancer (VISION). N Engl J Med. 2021.
  • Hofman MS, et al. [177Lu]Lu-PSMA-617 versus cabazitaxel in mCRPC (TheraP). Lancet. 2021.
  • Parker C, et al. Alpha emitter radium-223 and survival in metastatic prostate cancer (ALSYMPCA). N Engl J Med. 2013.
  • NNDC (Brookhaven National Laboratory). NuDat 3.0 — interactive nuclear structure and decay data. nndc.bnl.gov/nudat3.

Agent-specific references will be added as the page evolves.