Nathaniel J. Fernandes

Background:  Radionuclides are radioactive (i.e., ionizing radiation-emitting) forms of elements that occur naturally or are manmade that emit high-energy particles or waves like α particles (helium nuclei), β particles (electrons), or γ rays [1, 2, 3, 5]. While some radionuclides are byproducts of nuclear reactions, others are deliberately made for use in medical, commercial, or military applications [1, 4]. Although radionuclides have typically been used for diagnostic imaging in traditional cancer therapy, they are increasingly being developed as targeted cancer therapies that can locally irradiate tumors [6, 7], rather than current chemotherapies, which can have whole-body side effects. However, supply chain bottlenecks still exist, which currently hinder widespread adoption [10]. This review focuses on the current costs and benefits of radionuclides, specifically in prostate cancer.

Methods:  We conducted a systematic search using Google Scholar and PubMed. Search terms included “radionuclide cancer therapy” and “targeted radioligand therapy”. Peer-reviewed articles published from 2020 to 2026 were included, focusing specifically on prostate cancer.

Results:  The literature indicates that targeted radionuclide therapies show significant efficacy in the treatment of metastatic castration-resistant prostate cancer (mCRPC) with improved progression-free survival (median, 8.7 vs. 3.4 months) and overall survival (median, 15.3 vs. 11.3 months) compared to standard-of-care treatments [10]. Recently, as of March 28, 2025, the FDA has approved Pluvicto™ (Lu-177) to be used before chemotherapy [8]. This therapy selectively binds to tumor-specific antigens (i.e., PSMA) to deliver a localized dose of ionizing radiation that induces DNA damage and tumor cell death while minimizing exposure to surrounding healthy tissue. This localized nature has the positive effect of reducing side effects caused by system toxicity; however, renal toxicity remains a concern as the drug is still radioactive during excretion [10].

From an engineering and production perspective, there are supply chain bottlenecks that can delay treatment and limit accessibility. For example, the current market cost for Yb-176 (a Lu-177 precursor) is currently $20 million/kg [9]. Traditional manufacturing relies on nuclear reactors (which are heavily regulated) or cyclotrons; however, newer startups like ASP Isotopes, Inc., are attempting to use finely tuned lasers, which will potentially reduce costs. Overall, advances in isotope production methods and distribution infrastructure are ongoing but remain a critical bottleneck.

Conclusions: In conclusion, targeted radionuclide therapy improves survival in metastatic prostate cancer while reducing systemic side effects through localized radiation delivery. However, given the high production costs, the supply chain currently restricts widespread access, which highlights the need for more advances in isotope manufacturing. Overall, radionuclides are a promising future direction in cancer research and will be of increasing significance in the coming decades.

Works Cited

1. “Radionuclides | US EPA,” US EPA, Feb. 19, 2026. https://www.epa.gov/radiation/radionuclides
2. “Radiation Terms and units | US EPA,” US EPA, Mar. 24, 2026. https://www.epa.gov/radiation/radiation-terms-and-units
3. “Radiation Basics | US EPA,” US EPA, Mar. 24, 2026. https://www.epa.gov/radiation/radiation-basics
4. A. Galindo, “What is Radiation?,” IAEA, Jan. 25, 2023. https://www.iaea.org/newscenter/news/what-is-radiation
5. “About Non-Ionizing radiation,” Radiation and Your Health, Feb. 22, 2024. https://www.cdc.gov/radiation-health/about/non-ionizing-radiation.html
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7. B. C. H. Van Der Wal and E. Dadachova, “Targeted radionuclide therapy of cancer and infections,” International Journal of Molecular Sciences, vol. 24, no. 10, p. 9081, May 2023, doi: 10.3390/ijms24109081.
8. “FDA approves Novartis radioligand therapy Pluvicto® for earlier use before chemotherapy in PSMA-positive metastatic castration-resistant prostate cancer,” Novartis. [Online]. Available: https://www.novartis.com/news/media-releases/fda-approves-novartis-radioligand-therapy-pluvicto-earlier-use-chemotherapy-psma-positive-metastatic-castration-resistant-prostate-cancer
9. “OCEAN WALL ASP Isotopes -Enriching Our Future One Industry at a Time,” 2025. Accessed: Apr. 23, 2026. [Online]. Available: https://oceanwall.com/wp-content/uploads/2025/02/ASPI-Report-February-2025.pdf
10. O. Sartor et al., “Lutetium-177–PSMA-617 for Metastatic Castration-Resistant prostate cancer,” New England Journal of Medicine, vol. 385, no. 12, pp. 1091–1103, Jun. 2021, doi: 10.1056/nejmoa2107322.