213Bi-PSMA-617 targeted alpha-radionuclide therapy in metastatic castration-resistant prostate cancer

Prostate-specific membrane antigen radioligand therapy (PSMA-RLT) with 177Lu-PSMA holds great promise as a safe treatment option in patients with metastasized castration-resistant prostate cancer (mCRPC) with appropriate selection. This approach, together with 68Ga-PSMA PET/CT, is an excellent example of theranostic nuclear medicine. However, more structured data have recently shown that despite a marked response to PSMARLT, some patients are refractory to 177Lu-radioligand therapy. Fortunately recent studies have demonstrated that targeted α-radiation therapy with 225Ac-PSMA can significantly benefit mCRPC patients. Similarly, 213Bi-DOTATOC may be able to break the radioresistance to β-emitters while simultaneously reducing haematological toxicity in patients with diffuse red marrow infiltration by neuroendocrine tumour.