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Opinion|Videos|May 13, 2026

Patient Selection for Radiopharmaceuticals in Metastatic Castration-Resistant Prostate Cancer

Author(s)Pedro C. Barata, MD, MSc, FACP , Johann de Bono, MD, PhD

Dr. Pedro Barata and Dr. Johann De Bono discuss how patient selection and disease characteristics influence the use of radiopharmaceuticals in metastatic castration-resistant prostate cancer (mCRPC).

Episodes in this series

EP. 1 Radiopharmaceutical Strategies in Metastatic Castration-Resistant Prostate Cancer

EP. 1 Radiopharmaceutical Strategies in Metastatic Castration-Resistant Prostate Cancer

EP. 2 Combination Radiopharmaceutical Approaches in Metastatic Castration-Resistant Prostate Cancer

EP. 2 Combination Radiopharmaceutical Approaches in Metastatic Castration-Resistant Prostate Cancer

EP. 3 Alpha-Emitting Therapies in Metastatic Castration-Resistant Prostate Cancer

EP. 3 Alpha-Emitting Therapies in Metastatic Castration-Resistant Prostate Cancer

EP. 4 Patient Selection for Radiopharmaceuticals in Metastatic Castration-Resistant Prostate Cancer

EP. 4 Patient Selection for Radiopharmaceuticals in Metastatic Castration-Resistant Prostate Cancer

EP. 5 Treatment Sequencing in Metastatic Castration-Resistant Prostate Cancer

EP. 5 Treatment Sequencing in Metastatic Castration-Resistant Prostate Cancer

EP. 6 Combination and Sequencing Strategies in Metastatic Castration-Resistant Prostate Cancer

EP. 6 Combination and Sequencing Strategies in Metastatic Castration-Resistant Prostate Cancer

EP. 7 Safety and Toxicity Management in Metastatic Castration-Resistant Prostate Cancer

EP. 7 Safety and Toxicity Management in Metastatic Castration-Resistant Prostate Cancer

EP. 8 Future Radiopharmaceutical Strategies in Metastatic Castration-Resistant Prostate Cancer

EP. 8 Future Radiopharmaceutical Strategies in Metastatic Castration-Resistant Prostate Cancer

EP. 9 Personalized Treatment Decision-Making in Metastatic Castration-Resistant Prostate Cancer

EP. 9 Personalized Treatment Decision-Making in Metastatic Castration-Resistant Prostate Cancer

EP. 10 Future Directions in Metastatic Castration-Resistant Prostate Cancer

EP. 10 Future Directions in Metastatic Castration-Resistant Prostate Cancer

Dr. Pedro Barata and Dr. Johann De Bono discuss how patient selection and disease characteristics influence the use of radiopharmaceuticals in metastatic castration-resistant prostate cancer (mCRPC). Dr. De Bono reviews practical considerations for selecting between bone-targeting therapies such as radium Ra 223 dichloride and PSMA-targeted radioligand therapies, emphasizing the importance of disease burden, metastatic distribution, imaging characteristics, and tolerability. The faculty discuss how radium Ra 223 dichloride may remain particularly relevant for patients with bone-only or lower-volume bone metastases, while PSMA-targeted therapies offer broader tumor-directed approaches supported by PSMA PET imaging. Dr. De Bono also highlights the growing role of actinium-225–based therapies and ongoing clinical development in this space. In addition, the discussion explores challenges associated with PSMA-low or PSMA-negative disease, particularly liver metastases, and emerging strategies aimed at enhancing PSMA expression to potentially improve radiopharmaceutical targeting and therapeutic response in mCRPC.

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