When Radioligand Therapy May Be Right for Advanced Prostate Cancer

If your initial prostate cancer treatment hasn’t slowed the disease, you probably have a lot of questions. What comes next? Does this mean there’s nothing left to do?

These days, there are more treatment options than ever — even if the cancer has spread beyond your prostate or stopped responding to hormone therapy.

One of those advances is radioligand (PSMA-targeted) therapy, which allows doctors to deliver cancer-fighting therapy directly to prostate cancer cells throughout your body. Radiation oncologist Shalini Moningi, MD, explains how it differs from other treatments and when it may be the right fit for you.

What makes this treatment different?

Traditional radiation therapy delivers radiation from outside your body. But radioligand therapy works from the inside.

A radioligand is a type of targeted, radioactive medication. It travels through your bloodstream, seeking out prostate cancer cells and delivering radiation wherever it finds them — both in the prostate area and anywhere it’s spread. Because radioligand therapy specifically zeroes in on cancer cells, it’s also generally less damaging to healthy tissues than many traditional cancer treatments.

“It’s given by IV infusion, and it basically targets prostate cancer cells all over your body,” Dr. Moningi explains. It can:

• Shrink tumors
• Slow tumor growth
• Lessen symptoms

A 2025 trial found that men who received radioligand therapy experienced much longer periods without disease progression — about 18 months, compared with about seven months for those who received standard radiation alone.

You may also hear radioligand therapy for prostate cancer called by:

• Its full medical name, lutetium Lu 177 vipivotide tetraxetan
• Its brand name, Pluvicto™
• Other abbreviated terms, like lutetium PSMA therapy or Lu177-PSMA

How does radioligand therapy fit into treatment for advanced prostate cancer?

Radioligand therapy is an option for treating metastatic castration-resistant prostate cancer (mCRPC) that is PSMA-positive. But what exactly does all that mean? Dr. Moningi breaks it down word by word:

• Metastatic: This means the cancer has spread beyond the prostate and formed tumors in other parts of your body, like your lymph nodes, bones or organs.
• Castration-resistant: Radioligand therapy treats prostate cancer that has continued to grow, despite treatment to lower testosterone levels.
• PSMA-positive: “If a PSMA PET scan shows that the cancer has high levels of a protein called prostate-specific membrane antigen (PSMA), then radioligand therapy can target radiation specifically to those cells,” Dr. Moningi says.

Before trying radioligand therapy, you’ll likely begin with other treatments, like androgen deprivation therapy (ADT) and chemotherapy.

“Most people with advanced prostate cancer will need to undergo multiple types of therapies,” Dr. Moningi notes. “For us as doctors, then, it’s all about figuring out which therapy is most appropriate at each point along the way.”

That doesn’t mean radioligand therapy is a last resort. It just means that providers typically try more established treatments first. Then, if they need to, they look to newer options — with the goal of preserving your quality of life for as long as possible.

Possible future uses for radioligand therapy

Right now, radioligand therapy is only used in cases of metastatic castration-resistant prostate cancer (mCRPC) that is PSMA-positive. But it may be able to help even more people in the future.

Researchers are studying whether radioligand therapy could help with other forms of advanced prostate cancer, like:

• Metastatic hormone-sensitive prostate cancer (mHSPC): This is when cancer has spread beyond the prostate, but is still responding to hormone treatments. “Recent trials show that people who have newly diagnosed metastatic prostate cancer could benefit from this treatment,” Dr. Moningi shares.
• Oligometastatic prostate cancer: Researchers believe radioligand therapy may eventually be able to replace or complement hormone therapy in people with fewer than five tumors. “This is still being investigated from a research perspective,” Dr. Moningi clarifies. “But if so, it may be able to help people earlier in the course of their disease, with a shorter duration of hormone therapy.”

How your care team decides

A PSMA PET scan will help your care team determine whether you’re a candidate for this type of treatment. And if the cancer itself meets all the criteria, your team will still need to make sure the treatment is a good fit for you in other ways.

They’ll base this decision on factors like:

• Your disease progression
• Your overall health
• Your personal preferences
• What treatments you’ve already had

Treatment decisions are very individual, which means that what’s right for someone else may not be right for you (and vice versa). If you have specific questions about radioligand therapy and whether you’re a candidate for it, discuss them with your provider.

Final thoughts

Radioligand therapy isn’t the right treatment for everyone with prostate cancer, or for every stage of the disease. But for people whose cancer is a good match, it may help slow the disease’s progression.

It’s not a cure, but it may help you feel better for longer. And when you’re living with advanced cancer, that matters. A lot.

“The goal of all of this is to improve your quality of life,” Dr. Moningi emphasizes. “We want to help you live comfortably for as long as possible.”