Optimal patient management protocols for metastatic castration-resistant prostate cancer (mCRPC) are poorly defined and even further complexified with new therapy approvals, such as radiopharmaceuticals. The prostate-specific membrane antigen (PSMA)–targeted agent ¹⁷⁷Lu vipivotide tetraxetan ([¹⁷⁷Lu]Lu-PSMA-617), approved after the phase III VISION study, presents physicians with additional aspects of patient management, including specific adverse event (AE) monitoring and management, as well as radiation safety. Drawing on our experience as VISION study investigators, here we provide guidance on best practices for delivering PSMA-targeted radiopharmaceutical therapy (RPT) to patients with mCRPC. After a comprehensive review of published evidence and guidelines on RPT management in prostate cancer, we identified educational gaps in managing the radiation safety and AEs associated with [¹⁷⁷Lu]Lu-PSMA-617. Our results showed that providing sufficient education on AEs (e.g., fatigue and dry mouth) and radiation safety principles is key to effective delivery and management of patient expectations. Patient counseling by health care professionals, across disciplines, is a cornerstone of optimal patient management during PSMA-targeted RPT. Multidisciplinary collaboration is crucial, and physicians must adhere to radiation safety protocols and counsel patients on radiation safety considerations. Treatment with [¹⁷⁷Lu]Lu-PSMA-617 is generally well tolerated; however, additional interventions may be required, such as dosing modification, medications, or transfusions. Urinary incontinence can be challenging in the context of radiation safety. Multidisciplinary collaboration between medical oncologists and nuclear medicine teams ensures that patients are monitored and managed safely and efficiently. In clinical practice, the benefit-to-risk ratio should always be evaluated on a case-by-case basis.

转移性去势抵抗性前列腺癌 （mCRPC） 的最佳患者管理方案定义不明确，甚至随着放射性药物等新疗法的批准而进一步复杂化。前列腺特异性膜抗原 （PSMA） 靶向药物 ¹⁷⁷Lu vipivotide tetraxetan （^[177Lu]Lu-PSMA-617） 在 III 期 VISION 研究后获得批准，为医生提供了患者管理的其他方面，包括特定不良事件 （AE） 监测和管理，以及辐射安全。借鉴我们作为 VISION 研究者的经验，我们在这里提供了向 mCRPC 患者提供 PSMA 靶向放射性药物治疗 （RPT） 的最佳实践指南。在全面回顾了已发表的前列腺癌 RPT 管理证据和指南后，我们确定了在管理与 [¹⁷⁷Lu]Lu-PSMA-617 相关的辐射安全和 AE 方面的教育差距。我们的结果表明，提供有关 AE（例如疲劳和口干）和辐射安全原则的充分教育是有效提供和管理患者期望的关键。在 PSMA 靶向 RPT 期间，由医疗保健专业人员跨学科提供患者咨询是最佳患者管理的基石。多学科合作至关重要，医生必须遵守辐射安全方案，并就辐射安全注意事项向患者提供咨询。用 [¹⁷⁷Lu]Lu-PSMA-617 治疗通常耐受性良好;然而，可能需要额外的干预措施，例如剂量调整、药物或输血。在辐射安全方面，尿失禁可能具有挑战性。 肿瘤内科医生和核医学团队之间的多学科合作确保患者得到安全有效的监测和管理。在临床实践中，应始终根据具体情况评估获益风险比。