How to cite: Collins SP. Radiopharmaceuticals. Grand Rounds in Urology. November 2025. Accessed January 2026. https://grandroundsinurology.com/radiopharmaceuticals/
Summary
Sean P. Collins, MD, PhD, Professor and Vice Chair of Faculty Affairs, Department of Radiation Oncology, Morsani College of Medicine, University of South Florida, Tampa, Florida, discusses the expanding field of targeted radionuclide therapy for metastatic prostate cancer. He begins with radium-223, which is approved for symptomatic metastatic castrate-resistant prostate cancer, and summarizes the ALSYMPCA trial, showing improved overall survival and delayed skeletal events. He notes that despite its efficacy, use has declined, possibly due to reliance on prostate-specific antigen (PSA) response rather than alkaline phosphatase or pain improvement, which better predict benefit.
Dr. Collins highlights the evolving biomarker landscape, suggesting that circulating tumor DNA may complement or eventually surpass PSA for disease monitoring. He reviews lutetium-177 PSMA, emphasizing results from the PSMAfore and related trials. These results show improved radiographic progression-free survival and maintenance of quality of life. He cites combination strategies with androgen-receptor pathway inhibitors such as enzalutamide, which demonstrate higher PSA responses and prolonged survival, albeit modestly.
Quality-of-life data reveal improved physical function, reduced fatigue, and better pain control with lutetium therapy. Reported toxicities include mild xerostomia, anorexia, and nausea. Dr. Collins anticipates a broader integration of radionuclide therapies, including α-emitters, which may better target micrometastatic disease through high-energy, short-range radiation.
He describes the emerging use of radiolabeled antibodies such as TLX591 from Telix Pharmaceuticals, designed for longer tumor retention and fewer doses, though with potential marrow toxicity. Dr. Collins argues that individualized dosimetry, patient-specific dosing, and combination radionuclide strategies will define the next decade of precision therapy in prostate cancer.
ABOUT THE AUTHOR
Sean P. Collins, MD, PhD, is a Professor of Radiation Oncology and the Vice Chair of Faculty Affairs at the University of South Florida Morsani College of Medicine in Tampa, Florida. In July 2006, Dr. Collins joined his twin brother Brian on the faculty of the Cancer Center at Georgetown University Hospital as an Attending Physician in Radiation Oncology. Dr. Collins graduated from the Medical Scientist Training Program (MSTP) at the University of Michigan in 2001. Dr. Collins completed both an internship in Surgery and a residency in Radiation Oncology at Georgetown University Hospital. His area of expertise is prostate cancer, for which he treats patients using the CyberKnife®, a technology that allows for more accurate targeting of radiation therapy. Dr. Collins is a physician-scientist, and his work focuses on developing prostate cancer treatment protocols using stereotactic body radiation therapy (SBRT) to minimize the toxicity of radiation dose escalation. To date, he has treated over 2500 prostate cancer patients with SBRT and has presented his work at major meetings and published multiple papers on his experience in peer-reviewed journals.
