Prostate cancer is the second cancer cause and the fifth leading cancer death worldwide in men. Conventional imaging studies such as computed tomography, magnetic resonance imaging and bone scintigraphy have limitations to evaluate disease status. New positron emitting tomography (PET) tracer, 68Ga-PSMA, first conducted in 2012, has shown excellent ability in restaging of biochemical recurrence with low prostate specific antigen (PSA) level. Further studies extended the application to primary staging and monitoring therapeutic response. Cancer cell expression of PSMA exhibited by 68Ga-PSMA can be treated with 177Lu-PSMA. Several Phase II clinical trials shown that 177Lu-PSMA is safe and effective as a third line therapy. The first Phase III trial is aimed to compare 177Lu-PSMA and salvage radiotherapy. Moving forward from third line therapy to second line is attempted if clinical benefit is proved.
　　Target alpha therapy (TAT) with alpha emitters has been investigated recently. Refractory to beta emitters such as 177Lu-PSMA is expected to be candidate to TAT since short range of alpha particles carrying stronger energy kills cancer cell in more effective way. Preliminary results of 225Ac-PSMA therapy showed limited side effect with excellent response in either significant PSA decline or decreased 68Ga-PSMA uptake. 213Bi-PSMA is another TAT with higher perfusion-dependent off-target radiation and longer biological half-life. Potential candidate of alpha-emitting radioisotopes such as 212Pb is under investigation.
　　Personalized treatment plans mainly base on molecular profiles, and nuclear medicine studies serve as the most powerful noninvasive functional approach. By applying diagnosis result directly to therapy, which from 68Ga-PSMA to 177Lu-PSMA is the best example of theranostics, has lead treatment of prostate cancer to a new ear.