Radiopharmaceutical Strategies in Metastatic Castration-Resistant Prostate Cancer

Dr. Pedro Barata and Dr. Johann De Bono open the discussion by reviewing the evolving role of radiopharmaceuticals in metastatic castration-resistant prostate cancer (mCRPC) and outlining how these therapies are being integrated into the broader treatment landscape. Dr. De Bono discusses the development of radiopharmaceutical approaches in mCRPC, beginning with radium Ra 223 dichloride as an established bone-targeting alpha-emitting therapy associated with improved survival outcomes and the importance of bone-protective agents in mitigating fracture risk. The conversation then transitions to PSMA-targeted radioligand therapies and the distinctions between alpha- and beta-emitting agents, including differences in penetration, energy delivery, efficacy, and toxicity profiles. Dr. De Bono also highlights emerging next-generation compounds and explains how these therapies induce tumor cell death through DNA damage. Together, the faculty provide a practical and evidence-based overview of the rapidly evolving radiopharmaceutical landscape in mCRPC.