Prostate cancer is a major global health care challenge. Due to the recent relevant improvements in the diagnosis, imaging and treatment, management of these patients is becoming extremely complex. However, new multiple diagnostic procedures and treatment options, tailored on the single patient, require a multidisciplinary effort. Molecular imaging is gaining importance in the decision making process of prostate cancer patients, playing a key role in the majority of clinical setting, including staging, restaging during biochemical recurrence and castration-resistant stage. Moreover recent significant advances are changing the management of these patients impacting on the choice of therapeutic strategy. In particular, prostate-specific membrane antigen PET imaging is assuming the role of the gatekeeper addressing patients to the correct treatment option and also, in the advanced stages, selecting patients potentially suitable for targeted α- or β-therapy bridging to the fascinating concept of theranostic. Even if radioligand therapy found its first clinical application in 1946, in the last few years several α- or β-radionuclide prostate-specific membrane antigen-labeled for targeted therapy have been proposed where other treatment options do not show a significant impact on survival. The theranostic field is experiencing a rapid growth in prostate cancer giving to nuclear medicine a central role that has to be confirmed by further prospective studies.
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