Guideline of guidelines: lutetium-177 PSMA radioligand therapy in advanced prostate cancer
Abstract
OBJECTIVE: To synthesise current international guidance on lutetium-177-labelled prostate-specific membrane antigen (177Lu-PSMA) radioligand therapy (RLT) across the prostate cancer disease spectrum, with emphasis on metastatic castration-resistant prostate cancer (mCRPC) and emerging earlier-line indications.
METHODS: A structured literature overview was conducted. PubMed, EMBASE, and official repositories of major urological, oncological, and nuclear medicine societies were searched from inception to 31 October 2025 for prostate cancer guidelines. National and international guidelines or consensus statements published in English were eligible if they provided explicit recommendations regarding 177Lu-PSMA-RLT in their most recent version. Documents without therapeutic recommendations or superseded by updated versions were excluded. Six major society guidelines were included: European Association of Urology (EAU 2025), American Urological Association/Society of Urologic Oncology (AUA/SUO 2023), National Comprehensive Cancer Network (NCCN 2025), Canadian Urological Association (CUA 2024), American Society of Clinical Oncology (ASCO 2025), and European Society for Medical Oncology (ESMO 2020). The joint European Association of Nuclear Medicine/Society of Nuclear Medicine and Molecular Imaging (EANM/SNMMI 2023) procedural guideline and expert consensus from the Advanced Prostate Cancer Consensus Conference (APCCC 2024) were also reviewed.
RESULTS: All societies except ESMO,…
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