Advanced prostate cancer that keeps growing despite hormone therapy is one of the most difficult moments in a man’s cancer journey. PSMA therapy for prostate cancer, a form of targeted radioligand (theranostic) treatment, has changed that outlook for many patients by delivering radiation directly to cancer cells while sparing healthy tissue.
Prostate cancer is now projected to be the third most common cancer among Indian men, with a cumulative lifetime risk of roughly 1 in 125 (National Cancer Registry Programme, ICMR-NCDIR). As diagnosis rates rise, so does the need for advanced, evidence-based treatment options for men whose disease has spread or stopped responding to conventional therapy, which is exactly where PSMA-targeted radioligand therapy fits in.
What Is PSMA Therapy for Prostate Cancer?
PSMA therapy is a targeted nuclear medicine treatment that attaches a radioactive isotope to a molecule that binds specifically to Prostate-Specific Membrane Antigen (PSMA), a protein highly expressed on prostate cancer cells, delivering radiation directly to the tumor while largely sparing healthy organs.
PSMA is overexpressed on the surface of most prostate cancer cells, especially in advanced and metastatic disease. The therapy uses a “radioligand”, a PSMA-binding molecule carrying a radioactive isotope (Lutetium-177 or Actinium-225). Once injected, it travels through the bloodstream and selectively attaches to PSMA-positive cancer cells anywhere in the body, including bone and lymph node metastases. It is a form of precision/theranostic oncology; the same PSMA molecule used for diagnosis (PSMA PET scan) is also used for treatment.
In short, PSMA therapy turns the cancer’s own biology, its need to overexpress PSMA, into the very thing that targets and destroys it.
How Does PSMA-Targeted Radioligand Therapy Work?
PSMA therapy works in three steps, mapping the cancer with a PSMA PET scan, injecting a radiolabelled PSMA-binding molecule that seeks out cancer cells throughout the body, and allowing the attached radioactive isotope to destroy those cells from within over several treatment cycles.
- Step 1: Mapping: A PSMA PET scan confirms the tumour is PSMA-positive and maps every site of disease in the body.
- Step 2: Targeting: The radioligand is infused intravenously and binds selectively to PSMA on cancer cell surfaces.
- Step 3: Destruction: The radioactive isotope, beta-emitting Lutetium-177 or alpha-emitting Actinium-22, releases localised radiation that damages cancer-cell DNA, while healthy tissue receives minimal exposure.
Treatment is typically given as multiple cycles, spaced 6-8 weeks apart, with imaging and blood work between cycles to track response.
This selective, cell-by-cell targeting is what separates PSMA radioligand therapy from conventional external-beam radiation, which cannot reach cancer that has spread throughout the skeleton or lymphatic system.
Who Is Eligible for PSMA Therapy?
PSMA therapy is generally recommended for men with metastatic castration-resistant prostate cancer (mCRPC) whose disease is confirmed PSMA-positive on PET imaging and who have adequate kidney function and bone marrow reserve.
- Disease has progressed despite androgen deprivation therapy (hormone therapy), i.e., castration-resistant prostate cancer.
- Prior treatment with androgen-receptor pathway inhibitors (such as abiraterone or enzalutamide) and/or taxane chemotherapy in many treatment protocols.
- Tumours must show strong PSMA uptake on a PSMA PET-CT scan, with no significant FDG-positive/PSMA-negative disease.
- Kidney function and bone marrow reserve are checked through blood tests and a DTPA renal scan before starting.
- Men newly diagnosed with localised, early-stage prostate cancer are not typical candidates; PSMA therapy is primarily for advanced or metastatic disease.
Eligibility is always confirmed through imaging and lab work first, not assumed from staging alone; this is why the pre-treatment PSMA PET scan is non-negotiable.
Lutetium-177, Actinium-225 & Terbium-161 PSMA Therapy: Which One Is Right for You?
Lu-177 PSMA therapy is usually the first treatment tried; Ac-225 PSMA therapy is a stronger option kept in reserve for when Lu-177 stops working; and Terbium-161 PSMA therapy, a newer option that Dr. Swagat Dash was the first in India to offer his patients, is used to target very small or hard-to-reach traces of cancer more precisely.
- Lu-PSMA Therapy: The standard, first-choice option for most patients. Well-tested worldwide, FDA and Europe-approved, with a strong safety track record.
- Ac-PSMA Therapy: A more powerful option Dr. Dash turns to when cancer no longer responds to Lu-177, or in tougher cases from the start.
- Terbium-161 (Tb-161) PSMA Therapy: A next-generation option that can reach and destroy very tiny cancer deposits more effectively than Lu-177, useful for patients whose cancer has come back or spread in small amounts. Early trial results are encouraging: half or more of patients saw their PSA levels drop significantly, with mild side effects overall. Dr. Swagat Dash became the first nuclear medicine specialist in India to offer this therapy to his patients, starting June 2025.
Which one is right for you depends on your scans, past treatments, and how your cancer has behaved, a decision Dr. Dash makes case by case, not on a fixed rule.
How Effective Is PSMA Therapy: What the Clinical Evidence Shows?
Large studies show PSMA therapy slows down advanced prostate cancer and helps patients live longer, Lu-177 as the first-choice treatment, and Ac-225 or Tb-161 as strong follow-up options when Lu-177 stops working.
- Lu-177 PSMA therapy: In a major international trial of 831 patients, men who received Lu-177 PSMA therapy lived a median of 15.3 months, compared to 11.3 months without it, and their cancer stayed under control for 8.7 months on average, compared to 3.4 months without it (Sartor O, et al., New England Journal of Medicine, 2021, the VISION trial). It also outperformed chemotherapy in a separate trial, with more patients responding and fewer serious side effects (Lancet Oncology, TheraP trial).
- Ac-225 PSMA therapy: For patients whose cancer has already stopped responding to Lu-177, Ac-225 has still been able to bring PSA levels down by half or more in roughly 6 out of 10 patients, based on pooled results across multiple studies (Feuerecker B, et al., European Urology, 2021; confirmed in a larger review of 15 studies).
- Tb-161 PSMA therapy: In early trial results, this newer option brought PSA levels down by half or more in 7 out of 10 patients, and by 90% or more in 4 out of 10 patients, with mostly mild side effects (Kostos LK, et al., Lancet Oncology, 2025, the VIOLET trial).
These results come from patients with advanced, previously treated cancer, the kind that no longer responds to standard hormone therapy, which is exactly the group PSMA therapy is designed for.
These numbers are averages from research studies, not a guarantee for any one person, but together, they show that PSMA therapy, in one form or another, gives most patients a real chance at slowing their cancer down, even after other treatments have stopped working.
PSMA Therapy: The Treatment Process
PSMA therapy at Theranostics Centre involves an initial PSMA PET scan and blood work, followed by 4-6 outpatient treatment cycles spaced roughly 6-8 weeks apart, each involving a short intravenous infusion and brief radiation-safety observation.
- Pre-treatment work-up: Whole-body PSMA PET scan, kidney function tests, DTPA renal scan, and complete blood counts.
- Cycle administration: A short IV infusion of the radioligand (typically ~200 mCi per cycle for Lu-177, adjusted individually) is given in a dedicated nuclear medicine suite.
- Radiation safety: Standard precautions are explained by the Radiation Safety Officer; most patients can go home the same day with simple guidance for the first 24-48 hours.
- Monitoring: Serum PSA, kidney function, and periodic PSMA PET-CT imaging track how well the tumour is responding between cycles.
- Cycle count: Most protocols run 4-6 cycles, though this is adjusted based on response and tolerance.
Every cycle is followed by a review with Dr. Dash’s team so that dosing, spacing, and continuation are tailored to how your cancer is actually responding, not fixed to a rigid template.
Side Effects and Safety of PSMA Therapy
PSMA therapy is generally well tolerated, with the most common side effects being mild fatigue, nausea, dry mouth, and temporary changes in blood counts; serious kidney or bone marrow complications are uncommon and are actively monitored throughout treatment.
- Fatigue and mild nausea in the days following infusion, usually manageable and short-lived.
- Dry mouth (more noticeable with Ac-225 due to salivary gland uptake).
- Temporary bone marrow suppression, monitored through regular blood counts.
- Kidney effects are rare, particularly with proper hydration protocols and pre-treatment renal function screening.
- Secondary cancers from radiation exposure are an extremely rare, long-term theoretical risk, consistent with other radionuclide therapies.
Compared with cytotoxic chemotherapy, most patients tolerate PSMA radioligand therapy with a meaningfully lighter side-effect burden, which is one reason it has become a preferred option in later lines of treatment.
PSMA Therapy Cost and Availability in India
PSMA therapy is available in India at select specialised nuclear medicine centres, including Theranostics Centre at Sarvodaya Hospital, Faridabad, with per-cycle costs depending on the isotope used, dosage, and number of cycles required, confirmed individually after PSMA PET-CT evaluation.
- Cost varies by isotope, dose, hospital stay requirements, and number of cycles, there is no single fixed “package price” that applies to every patient.
- India offers PSMA therapy at a significant cost advantage compared with the US and Europe, without compromising on isotope quality or protocol standards.
- A written cost estimate is provided only after your PSMA PET scan and blood work confirm eligibility; this avoids quoting a number that may not apply to your specific disease burden.
- Insurance and reimbursement policies vary; our team can guide you through documentation for eligible cases.
The most reliable way to get an accurate figure is a consultation and PSMA PET-CT review, anything quoted before that is, at best, a rough range.
Meet the Nuclear Medicine Specialist: Dr. Swagat Dash
Dr. Swagat Dash is the HOD & Associate Director of Nuclear Medicine at Sarvodaya Hospital, Faridabad, a nuclear medicine specialist with 19+ years of experience who led his centre to become the first in India to offer Terbium-161 PSMA therapy, and offers the complete range of PSMA-targeted treatments for prostate cancer under one roof.
- 19+ years of dedicated experience in nuclear medicine, with 1,00,000+ diagnostic scans and 1,000+ theranostic treatments delivered to date.
- He holds a DNB in Nuclear Medicine and is a Fellow of the European Board of Nuclear Medicine (FEBNM) and Fellow of the Asian Nuclear Medicine Board (FANMB), with international-standard training in a highly specialised field.
- Led Sarvodaya Hospital’s Centre for Nuclear Medicine & Theranostics to be recognised as an ICPO Clinical Theranostics Center of Excellence (2025) for endocrine neoplasia and prostate cancer.
- A member of leading professional bodies, including the Society of Nuclear Medicine, India (SNMI), EANM, and WARMTH, reflecting active involvement in the field beyond his own workspace.
- Offers wider range of targeted radionuclide therapies for other cancers, so patients don’t need to shuttle between centres.
If your cancer has stopped responding to hormone therapy, a conversation about PSMA eligibility, starting with a PET scan, is a reasonable next step to have with your treating oncologist.
Frequently Asked Questions
Is PSMA therapy a cure for prostate cancer?
No. PSMA therapy is not a cure, it is a highly effective disease-control treatment for advanced, hormone-resistant prostate cancer, shown in clinical trials to slow disease progression and extend survival.
What is the difference between a PSMA PET scan and PSMA therapy?
A PSMA PET scan is a diagnostic imaging test that maps where PSMA-positive cancer is present in the body; PSMA therapy uses a similar PSMA-targeting molecule, but attached to a therapeutic radioactive isotope, to treat that same cancer.
Can PSMA therapy be combined with hormone therapy or chemotherapy?
In many cases, yes, depending on individual response and prior treatment history, this is decided case by case after reviewing full clinical and imaging data.
Who is the best doctor for PSMA therapy in Faridabad?
When choosing a PSMA therapy specialist in Delhi NCR, patients should consider the doctor’s nuclear medicine qualifications, experience with radionuclide therapies, access to PSMA PET-CT and the availability of appropriate treatment and monitoring facilities. Dr. Swagat Dash practises at Sarvodaya Hospital, Faridabad, Delhi NCR, where the Theranostics Centre provides PET imaging and molecular theranostics services.
Who should I consult for PSMA therapy in Delhi NCR?
Dr. Swagat Dash at Theranostics Centre, Sarvodaya Hospital, Faridabad, offers PSMA therapy along with in-house PSMA PET-CT imaging for eligibility assessment and monitoring.