ABSTRACT
Prostate cancer is the second most common cancer in men and it can lead to death if left untreated. Early-stage prostate cancer is treated with radical prostatectomy or radiotherapy, while advanced-stage involves hormone therapies, taxane-based chemotherapies, and radionuclide treatments. Among radionuclide treatments, Lutetium-177 (Lu-177) prostate specific membrane antigen (PSMA) has proven its efficacy in overall survival with a phase III trial known as VISION trial and has found its place in guidelines. However, despite all these treatment efforts, resistance and progression may occur in some patients. In this context, alpha therapies have emerged as a new hope for advanced-stage prostate cancer patients who have exhausted all treatment options. Actinium-225 (Ac-225), an alpha emitter, is expected to have higher efficacy and potentially fewer side effects compared to beta emitters like Lu-177. Among alpha therapies, Ac-225 is the most clinically applied radionuclide. Ac-225 labelled PSMA radioligand therapies have shown promise in recent studies for future treatments in metastatic castration-resistant prostate cancer (mCRPC). This review will focus on the role of alpha therapy and the treatment responses, survival effects, and significant side effects of Ac-225 PSMA in patients with mCRPC.
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