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There is no denying the importance of prostate cancer as a leading cause of mortality and morbidity in men. As such, it represents an important driver of healthcare costs and there is a (mostly unmet) need to provide evidence that assists decision-makers in prioritizing one management strategy over another in budget planning.

Theranostics in prostate cancer represents a non-invasive out-patient strategy for patient management, which consists of imaging with a PSMA-based agent, followed by targeted radionuclide therapy with either a beta emitter (such as Lutetium-177) or an alpha emitter (such as Actinium-225). Evidence for these management approaches is mounting with FDA approval of imaging and therapy agents following landmark trials like the ProPSMA study, the VISION- and the TheraP trial. 

Despite the explosion in publications on the use of targeted radionuclide therapies in prostate cancer, studies that compare the cost-effectiveness of available nuclear medicine imaging and treatment strategies remain hard to find. The aim of this mini review was to summarize the most important current evidence related to cost-effectiveness strategies that evaluate imaging and targeted radionuclide therapies for PSMA-based PET theranostics.

We found a paucity of literature that deals with healthcare costs, with an obvious need for more cost-effectiveness studies to demonstrate the positive impact of nuclear medicine in the management of oncology (and other) patients. These studies need to be based on well-conducted clinical trials and meta-analyses, with appropriate model simulations and decision analysis and should ideally be reported according to the CHEERS 2022 guidelines to improve uniformity and robustness.