Metastatic prostate cancer: which patients can be assessed for lutetium-177 PSMA therapy?
If your doctor mentions Pluvicto (lutetium [177Lu] vipivotide tetraxetan), first confirm two things with your urologic oncology team: is your metastatic prostate cancer still sensitive to hormone therapy, or has it become castration-resistant? Does your PSMA imaging meet the treatment requirements? These answers affect which indication you can be assessed under in each country and which medicines you need to continue.
Before your appointment Give the nuclear medicine team your PSMA PET images, a timeline of androgen deprivation therapy and other cancer medicines, and recent blood count and kidney function results; obtain written arrangements for your appointment and radiation protection before you travel.
First, clarify whether your cancer is hormone-sensitive or castration-resistant
A report mentioning “bone metastases” and a PSA value are not enough to distinguish these stages. Ask your doctor to assess your testosterone levels, PSA changes, and imaging during androgen deprivation therapy (ADT). If you have already received androgen receptor pathway inhibitors (ARPIs), such as abiraterone or enzalutamide, or taxane chemotherapy, clearly record the start and stop dates and why treatment was stopped. PSMA PET requires a separate assessment: the nuclear medicine team reviews uptake in the lesions, their distribution, and any sites that do not match other imaging findings.
Current US prescribing information · European Medicines Agency Pluvicto product information
Which indications can you be assessed under in China, the United States, and the EU?
China announced an additional indication in August 2026, allowing patients with PSMA-positive metastatic hormone-sensitive prostate cancer to receive Pluvicto in combination with an ARPI; the United States had already approved the corresponding combination regimen in July of the same year. The pivotal PSMAddition study added it to existing ADT＋ARPI, so you need to confirm the ongoing hormone therapy arrangements with your treating doctor. Particular PET findings or not having received chemotherapy cannot, on their own, determine whether treatment is suitable.
For the castration-resistant stage, China has also approved treatment for certain PSMA-positive adult patients whose disease has progressed after an ARPI and who are considered appropriate to delay chemotherapy, as well as adult patients whose disease has progressed after prior ARPI treatment and taxane chemotherapy. The current EU label covers adults with progressive PSMA-positive metastatic castration-resistant prostate cancer who have received an ARPI and taxane chemotherapy, in combination with ADT, with or without an ARPI. Patients being assessed in the EU at the hormone-sensitive stage should check current prescribing provisions and available trials with their local urologic oncology team.
Novartis China indication announcement · US FDA · European Medicines Agency Pluvicto product information · Chinese approval records for the castration-resistant stage
What does the nuclear medicine team assess first?
Pluvicto delivers radioactive lutetium-177 close to lesions that express PSMA. Before treatment starts and before and after each administration, the team needs to check hemoglobin, white blood cells, platelets, and kidney function; also tell them in advance if you have recently had a blood transfusion or treatment that suppresses bone marrow, have difficulty urinating, or have an indwelling urinary catheter. Ask the hospital to specify whether PET scans from another facility can be reviewed, whether there is a time limit on test results, and whether additional tests are needed before arranging your travel.
The medicine must be administered by a specialist team authorized to use radiopharmaceuticals. An imaging center that offers PSMA PET may not provide treatment; ask the nuclear medicine team to confirm the hospital site, planned administration date, and medicine delivery arrangements. Changes in blood counts or kidney function may delay administration, and the written plan should state who will notify the patient if this happens.
EU product information and safety requirements
Ask for separate costs for the medicine, nuclear medicine procedures, and follow-up tests
In February 2026, Pudong Hospital affiliated with Fudan University reported a case in which Pluvicto had been administered. When requesting a quote from a nuclear medicine department in Shanghai, you can submit your latest PSMA PET results and treatment history for review and ask the hospital to itemize the radiopharmaceutical, procedures, observation, and follow-up tests based on the expected number of administrations.Case report from Shanghai Medical College of Fudan University
Ask the nuclear medicine department for an itemized quote for one administration, specifying the medicine, radioactive activity, administration procedure, observation, and whether a hospital stay is required. List PSMA PET, blood counts, and kidney function follow-up tests separately, then confirm the interval between treatments, expected number of administrations, arrangements for delays, and which tests can be completed where you live. Arrange your return journey after receiving the administration and radiation protection plans.
European Medicines Agency Pluvicto product information
How should you arrange your return journey if children or pregnant women live with you?
Before administration, tell the nuclear medicine team who lives with you, whether you sleep alone, whether a caregiver may come into contact with bodily fluids, and your planned flights. Ask for a written radiation protection schedule that separately specifies restrictions on close contact and sharing a bed with other adults, children, or pregnant women, along with instructions for using the toilet, cleaning, and hydration. Carry a document recording the medicine, administration date, and hospital telephone number to show if you encounter screening or need medical care on your return journey. If you develop a fever, bleeding, marked fatigue, or a significant change in urine output, seek medical care according to the emergency contact plan provided by the nuclear medicine department.
US FDA administration and radiation safety instructions · EU patient information
Frequently asked questions
If my PSA rises, can I schedule treatment without PSMA imaging?
The nuclear medicine team needs to review PSMA imaging that meets the eligibility criteria for the medicine. First submit the original files from your existing scans and ask whether repeat imaging is needed, which imaging agent should be used, and who will interpret the images.
Can I still be assessed if I have already received a newer hormone therapy?
The assessment first needs to establish whether your cancer is currently hormone-sensitive, which ARPI you previously received, whether the disease has progressed, and whether you have received taxane chemotherapy, then check the local label. The medicine's name alone cannot establish the treatment stage.
Can a previous bone scan replace PSMA PET?
A previous bone scan helps show the distribution of bone metastases, but the nuclear medicine team still needs to determine whether qualifying PSMA-targeted imaging is available. Provide both sets of images when you seek advice.
Do I need to continue my existing hormone therapy during treatment?
Do not stop your medicines on your own. At the hormone-sensitive stage, the approved use is in combination with an ARPI, and the pivotal study used ADT and an ARPI as the background treatment; ask the team to record in your treatment plan whether each medicine should continue and who will prescribe it.
Can I return home alone immediately after the first administration?
Tell the team about your transport, whether you will need someone to accompany you, and the family members who live with you before you travel. Base your discharge, transport, and accommodation arrangements on the test results for that visit, your condition after administration, and the center's written radiation protection requirements.
Can I get a fixed price for the entire course before deciding whether to travel abroad?
Ask the hospital to first confirm your pathology and PSMA imaging, provide quotes for one administration and subsequent follow-up tests under the proposed regimen, and explain which tests are included and when a new quote would be issued because of delays or dose adjustments. Then compare this with local treatment and out-of-pocket costs under your insurance.