Table 1.

Summary of patient selection, preparation and cautionary considerations.

Patient selection	Patients with mCRPC who are ineligible or finalized the approved alternative options and with adequate uptake of PSMA ligands on the basis of a pre-therapy imaging study can be considered for treatment [13].
	Uptake of tumors > liver uptake (at least 1.5 times the SUVmean) [16]. Liver metastases negative on PSMA-ligand PET should be ruled out, even if the remainder of the disease demonstrates intense PSMA expression [13].
	Life expectancy > 6 months ECOG performance status > 2 Unless the main objective is alleviating suffering from disease-related symptoms [13].
Patient preparation and cautionary considerations	Complete blood tests need to be performed within the two weeks before the 177Lu-PSMA therapy
	White blood cells > 2500/L Platelet > 75,000/L Hemoglobulin > 8 mg/dL If blood cell counts were below the suggested thresholds, blood cell transfusion can be considered to avoid adverse effects [13].
	Myelosuppressive therapies should be discontinued for protecting bone marrow reserves [14].
	Patients with obstructive urinary disorders which might be evaluated with 99m Tc-MAG3 or 99m Tc-DTPA scintigraphy should be resolved before the therapy to reduce the radiation exposure to the kidneys [15].
	Creatinine level should <2× upper limit of normal GFR > 30 mL/min [13].
	Liver transaminase levels should be <5× upper limit of normal [13].

mCRPC, Metastatic castration-resistant prostate cancer; PSMA, Prostate specific membrane antigen; SUV, Standardized uptake value; PET, Positron emission tomography; ECOG, Eastern Cooperative Oncology group; GFR, Glomerular filtration rate.