Most men with newly appreciated metastatic prostate cancer are optimally treated with a backbone consisting of androgen receptor–directed therapy with or without taxane chemotherapy. Despite improvements in disease outcomes, prostate cancer remains an extremely heterogeneous disease with variable mechanisms of therapeutic resistance. As a result, it remains a leading cause of cancer-related death in men. Radiopharmaceutical therapy has emerged as an alternative, non–androgen receptor–directed treatment modality for metastatic castration-resistant prostate cancer that impacts patient survival and represents a potentially more personalized approach. In this review, we aim to outline the current treatment landscape for metastatic prostate cancer with a focus on radiopharmaceutical therapy, specifically ¹⁷⁷Lu-PSMA-617. In addition, we illustrate various clinical challenges with ¹⁷⁷Lu-PSMA-617 treatment to date and explore investigative efforts to leverage radiopharmaceutical therapies as part of combination regimens or earlier in the treatment algorithm to further improve patient outcomes. Finally, we introduce ongoing studies of alternative radiopharmaceutical therapies in metastatic prostate cancer that may be incorporated into the treatment algorithm pending further study.

大多数患有新发现的转移性前列腺癌的男性都可以采用雄激素受体导向疗法（联合或不联合紫杉烷化疗）作为骨干进行最佳治疗。尽管疾病结果有所改善，但前列腺癌仍然是一种极其异质的疾病，具有不同的治疗耐药机制。因此，它仍然是男性癌症相关死亡的主要原因。放射性药物治疗已成为转移性去势抵抗性前列腺癌的另一种非雄激素受体导向的治疗方式，它影响患者的生存，并代表了一种潜在的更加个性化的方法。在这篇综述中，我们旨在概述转移性前列腺癌的当前治疗前景，重点是放射性药物治疗，特别是¹⁷⁷ Lu-PSMA-617。此外，我们还说明了迄今为止¹⁷⁷ Lu-PSMA-617 治疗面临的各种临床挑战，并探索了利用放射性药物疗法作为联合治疗方案的一部分或在治疗算法的早期阶段以进一步改善患者预后的研究工作。最后，我们介绍了正在进行的转移性前列腺癌替代放射性药物疗法的研究，这些研究可能会被纳入治疗算法中，以待进一步研究。