A targeting molecule carries radiation
Radiopharmaceuticals deliver radiation through a substance taken up by particular cells or receptors. Examples include radioiodine in selected thyroid cancers, somatostatin-receptor-directed treatment for selected neuroendocrine tumors and PSMA-directed therapy in prostate cancer. Each has a different selection pathway; “nuclear medicine” is not a single cancer drug.
| Pathway | Typical selection issue |
|---|---|
| Radioiodine | Whether a thyroid cancer retains iodine uptake and treatment is indicated. |
| Somatostatin-receptor therapy | Receptor expression, differentiation and the specific neuroendocrine-tumor setting. |
| PSMA radioligand therapy | PSMA imaging plus prostate-cancer disease state and treatment history. |
Source [1]
Imaging is part of the prescription
A suitable molecular-imaging scan may be needed to confirm target uptake and detect lesions unlikely to respond. Prior medicines, kidney function, marrow reserve and the pattern of disease matter. A positive scan alone does not override the product’s indication and treatment-line requirements.
A bright scan is not the entire eligibility decision
A target-positive scan helps show where a radioligand may deliver radiation. The team also needs to consider lesions with low or absent uptake, competing disease and organ reserve. Diagnostic tracer and treatment drug are not the same product, even when they recognize the same target.
Global treatment frontiers
PSMA radioligand treatment is moving earlier in the prostate-cancer pathway. After the 2025 US expansion in metastatic castration-resistant disease, a July 2026 FDA approval added lutetium Lu 177 vipivotide tetraxetan with androgen-receptor-pathway therapy for PSMA-positive metastatic androgen-pathway-modulation-naïve or -sensitive prostate cancer. This is a product-specific change in treatment sequence.
In China, Novartis reported in August 2026 that Pluvicto received approval with an androgen-receptor pathway inhibitor for PSMA-positive metastatic hormone-sensitive prostate cancer. Chinese research also explores other PSMA ligands, which require their own evidence and authorization. Selection still depends on the exact product, imaging findings, disease state and accompanying treatment.
Treatment cycles and radiation precautions
The pathway includes eligibility imaging, laboratory tests, dosing and reassessment between cycles. Kidney protection, hydration or other supportive steps depend on the medicine. Written precautions should cover contact with others, hygiene, travel and handling bodily fluids for the applicable period.
Supportive infusions have a specific purpose
For lutetium-177 dotatate, amino-acid infusion is used to reduce kidney radiation exposure; anti-nausea support may accompany it. Other radiopharmaceuticals have different protocols. Ask how long the complete visit lasts and which tests determine whether another cycle is safe rather than transferring one product’s schedule to another.
Source [5]
Protecting marrow and kidneys
Low blood counts, fatigue, nausea and organ-specific effects can limit treatment. PSMA therapies may cause dry mouth; some regimens have longer-term marrow risks. A licensed facility, reliable isotope supply and a follow-up partner are important, especially when treatment is arranged internationally.
Arrange radiation safety before the return journey
- Obtain written contact, hygiene and bodily-fluid precautions for the exact product.
- Discuss children, pregnancy, shared accommodation and continence needs in advance.
- Ask whether travel documentation or a radiation-treatment letter is needed.
- Confirm blood-count and kidney follow-up and who reviews results between cycles.
Estimated total treatment cost
Nuclear medicine treatment costs vary by radiopharmaceutical and treatment plan. The ranges below cover total medical costs for the named treatment pathways.
| Treatment pathway | Estimated total treatment cost |
|---|---|
| Iodine-131 for differentiated thyroid cancer | US$5,000–13,000 |
| PSMA therapy: Pluvicto | US$110,000–190,000 |
| PRRT: locally prepared Lu-177 DOTATATE | US$50,000–90,000 |
| PRRT: original-brand Lutathera | US$125,000–165,000 |
What’s included
The total includes the radiopharmaceutical or its preparation, specialist assessment, necessary laboratory tests and imaging, administration, radiation protection, nursing and monitoring, necessary hospitalization, routine supportive care and early follow-up. PRRT includes kidney-protective infusions and associated supportive medicines; the Pluvicto range includes basic androgen-deprivation therapy during treatment. Travel and accommodation are not included.
Your treatment plan
The iodine-131 range covers one administration and related medical care. PSMA therapy and PRRT costs depend on the product, number of administrations, accompanying medicines and care needs. Additional anticancer treatments and subsequent long-term maintenance are assessed separately. Product availability and eligibility depend on the treatment center and local requirements. Contact us for a personalized treatment cost estimate.
Evidence & sources
Prepared by Chirona’s content team from the sources below. This guide supports a discussion with your treating team; it does not determine an individual treatment plan.