Theranostics in Radiation Oncology: What Is It, and Why Is It Important? | CancerNetwork

Theranostics: The Bridge Between Nuclear Medicine and Radiation Oncology in Modern Cancer Care

BLUF (Bottom Line Up Front): Theranostics represents a paradigm shift in precision cancer treatment by combining diagnostic imaging with targeted radiopharmaceutical therapy. While traditional radiation oncology focuses on external beam radiation therapy (EBRT), theranostics falls primarily under nuclear medicine's domain, creating new collaborative care requirements across California and nationwide. Patients receiving these treatments need integrated team oversight to track cumulative radiation exposure from multiple sources, ensure coordinated care between specialties, and optimize treatment sequencing. FDA-approved theranostic agents currently exist for prostate cancer (Pluvicto/lutetium-177-PSMA-617) and neuroendocrine tumors (Lutathera), with alpha-emitting agents like actinium-225 showing promise in clinical trials for treatment-resistant disease. Major California academic centers—UCLA, UCSF, Stanford, UC San Diego Health, and City of Hope—have established comprehensive theranostics programs with varying organizational models, demonstrating both the promise and complexity of integrating this technology into routine cancer care.

What Is Theranostics?

Theranostics combines two concepts: "therapy" and "diagnostics." This approach uses molecularly identical radiopharmaceuticals—one labeled with an imaging isotope for diagnosis, the other with a therapeutic isotope for treatment. The diagnostic scan (typically a PET/CT) identifies whether tumor cells express specific molecular targets, while the therapeutic agent delivers focused radiation directly to those same targets throughout the body.[1,2,3]

"It's therapy merging with diagnostics—theranostics—and it's a form of precision medicine that is definitely emerging and getting more well-known across the world," explains Dr. Brandon Mancini, MD, MBA, FACRO, during the 2026 American College of Radiation Oncology (ACRO) Summit.[1]

The fundamental principle dates to 1947, when Dr. Samuel Seidlin first treated thyroid cancer with radioactive iodine—using the same element for both diagnosis and therapy.[4] In prostate cancer, the same prostate-specific membrane antigen (PSMA) molecule can be labeled with gallium-68 or fluorine-18 for diagnostic PET imaging, then labeled with lutetium-177 or actinium-225 for therapeutic radiopharmaceutical delivery.[2,4]

Unlike external beam radiation therapy (EBRT), which delivers radiation from outside the body to specific tumor locations, theranostic radiopharmaceuticals are injected intravenously and circulate throughout the body, seeking cancer cells wherever they exist. The radiation is then delivered continuously at the cellular level—"24 hours a day, 7 days a week, for several weeks but at the millimeter-type level, with very little damage or irritation to surrounding tissues," according to Dr. Mancini.[1]

How Theranostics Fits Into the Current Oncology Playbook

Modern cancer care increasingly relies on multidisciplinary approaches, and theranostics exemplifies this trend by requiring coordination across multiple specialties—a reality clearly demonstrated in clinical practice across California's major cancer centers.

Traditional Radiation Oncology's Role

Radiation oncology continues to focus on EBRT modalities including intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and brachytherapy. Radiation oncologists plan and deliver precise external radiation doses to known tumor locations, typically over several weeks of daily treatments.[5,6]

At UCLA, Dr. Amar Kishan serves as both a radiation oncologist and co-director of the Cancer Molecular Imaging, Nanotechnology and Theranostics (CMINT) research program, demonstrating how radiation oncology expertise contributes to theranostics development even when nuclear medicine administers the treatments.[7]

Nuclear Medicine's Theranostics Charter

Nuclear medicine has emerged as the primary specialty administering theranostic treatments across California and nationwide. Nuclear medicine physicians have expertise in handling radiopharmaceuticals, understanding radiation safety protocols, performing specialized imaging, and calculating absorbed radiation doses to organs throughout the body.[1,8,9]

UC San Diego Health was the first institution in San Diego to offer Pluvicto after its 2022 FDA approval, with theranostics administered through their nuclear medicine department as part of the Urologic Cancer Clinic's multidisciplinary approach.[10] The clinic brings together medical oncologists, urologic surgeons, and radiation oncologists for single-visit consultations, with nuclear medicine providing the theranostic delivery.

UCLA Health made organizational history in November 2025 by establishing the first independent Department of Nuclear Medicine and Theranostics in the United States.[3] Under acting chair Dr. Johannes Czernin and clinical research director Dr. Jeremie Calais, UCLA opened a 3,000-square-foot Outpatient Theranostics Center in February 2024 with eight infusion chairs and capacity for 80 treatments weekly (4,000 cycles annually).[8,11] The center employs four nurses, three nuclear medicine technologists, two radiation safety specialists, and nine physicians dedicated to theranostics.[8]

Dr. Calais, who led the phase II clinical trial for lutetium-177 PSMA and later the VISION trial that secured FDA approval, emphasizes the specialized infrastructure requirement: "Drugs that are radioactive cannot be administered in a large volume in a typical outpatient medical center. To handle more patients and radiopharmaceutical management, we needed a facility like this."[8]

UCSF Health houses theranostics within its Department of Radiology and Biomedical Imaging, with Dr. Thomas Hope serving as Director of Molecular Therapy and Dr. Robert Flavell as Chief of the Molecular Imaging and Therapeutics Clinical Section.[9,12] UCSF researchers are developing novel theranostic approaches beyond PSMA, including CD46-targeted alpha particle therapy with actinium-225 for PSMA-negative prostate cancer.[13]

Stanford Medicine operates theranostics through its Division of Nuclear Medicine and Molecular Imaging, with Dr. Erin Grady serving as interim division chief.[14] Stanford recently welcomed Dr. Umar Mahmood as the new chair of Radiology effective January 2026, specifically selected for his expertise in "translating molecular imaging to understand the drivers of cancer and its application in guiding precision medicine."[14] Stanford's team uses post-treatment SPECT imaging to assess response immediately after Pluvicto administration, determining whether patients are benefiting early enough to avoid ineffective additional cycles.[15]

City of Hope established a comprehensive theranostics program led by internationally recognized expert Dr. Phillip Kuo, who serves as Division Chief of Nuclear Medicine and Director of Theranostics.[16,17] Dr. Kuo led the design of novel PSMA-PET imaging criteria for the pivotal VISION trial and pioneered artificial intelligence analysis of PSMA-PET for FDA-mandated studies.[16] City of Hope operates a duo-licensed dispensing and manufacturing radiopharmacy on-site, enabling both preclinical and clinical radiopharmaceutical development.[18] In September 2025, City of Hope published detailed protocols for integrating PSMA-targeted theranostics into multidisciplinary care, highlighting that "theranostics is possibly the most complex program in nuclear medicine."[19]

Medical Oncology's Integration

Medical oncology provides systemic therapy expertise, helps sequence treatments, and often makes the initial referral for theranostics consideration when patients progress on standard therapies. At Stanford, Dr. Sandy Srinivas leads a collaborative team including "urologists, radiation oncologists, nuclear medicine scientists, and basic scientists" working to integrate theranostics into earlier disease stages.[15]

The Integration Challenge

Building successful theranostic programs requires "a clinical champion, good physics support and good clinical support from nursing and nuclear medicine technologists, and a good referral collaborative effort between other specialties," notes Dr. Mancini.[1] For radiation oncologists, theranostics represents "an add-on to what they're used to doing each day with brachytherapy or external beam radiation," requiring new collaborative frameworks.[1]

The varying organizational models across California institutions—from UCLA's independent department to UCSF's integration within radiology to UCSD's multidisciplinary clinic model—demonstrate that institutions are still determining optimal structures for theranostics delivery.

Tracking Total Body Radiation: A Critical Safety Imperative

One of the most important yet challenging aspects of integrating theranostics into comprehensive cancer care is tracking cumulative radiation exposure—a concern that becomes acute as patients receive radiation from multiple sources and potentially multiple institutions.

Multiple Radiation Sources

Patients may receive:

Diagnostic radiation from multiple PET/CT scans, conventional CT scans, and X-rays
EBRT to specific tumor sites or metastases
Theranostic radiopharmaceuticals that deliver systemic radiation
Brachytherapy (internal radiation) for localized treatment

Each radiation source contributes to total body exposure, with particular concern for dose-limiting organs like bone marrow, kidneys, and salivary glands.[20,21]

Patient-Specific Dosimetry in Theranostics

Unlike EBRT where individualized dosimetry calculations are standard practice, radiopharmaceutical therapies have traditionally been administered as fixed treatment activities without patient-specific dose calculations.[20] However, this paradigm is rapidly changing as evidence mounts that personalized dosimetry can "help maximize therapeutic effect while mitigating potential radiation-related toxicity."[20]

The basic paradigm for patient-specific dosimetry in theranostics includes:[21]

Administration of a pretreatment tracer activity
Measurement of time-dependent biodistribution through serial imaging
Integration of time-activity data to calculate source-region activities
Calculation of absorbed doses to tumors and organs-at-risk
Prescription of individualized therapeutic activity

Recent research demonstrates clear dose-response relationships. A 2024 study found a "90% probability of partial tumor response for an accumulated tumor-absorbed dose of at least 135 Gy" in lutetium-177 PSMA therapy, underscoring why dosimetry matters.[22]

Challenges in Tracking Across Modalities

Tracking cumulative radiation exposure across different modalities presents significant technical and practical challenges. Nuclear medicine dosimetry differs fundamentally from X-ray based procedures due to the radiation source (internal vs. external), biokinetics of radiopharmaceuticals, and measurement methodologies.[23] These differences "create challenges in applying monitoring and reporting strategies used in x-ray based procedures to nuclear medicine, and integrating dosimetry information across modalities."[23]

Occupational and Patient Dose Tracking

For healthcare workers, cumulative radiation monitoring across multiple employment sites remains inconsistent despite regulatory intent. A 2022 survey of radiation safety officers revealed gaps: while experienced RSOs often request dosimetry records for employees working at multiple institutions, "not all institutions are tracking these records."[24] If tracking occupational exposure proves challenging, patient exposure across multiple treatment sites poses even greater complexity.

Who Coordinates Radiation Safety?

Nuclear medicine physicians calculate radiation dosimetry—the absorbed dose to normal organs—to ensure safety limits are not exceeded.[1,20,21] This requires sophisticated physics support and careful coordination between all treating physicians.

Patients should ask their care team:

Who is tracking my total radiation exposure across all treatments?
What are the cumulative dose limits for critical organs like kidneys, bone marrow, and salivary glands?
How will different radiation treatments be sequenced to minimize toxicity?
Which specialist is coordinating my overall radiation safety?
Do I need patient-specific dosimetry calculations rather than standard fixed dosing?

Stanford's approach demonstrates best practices: nuclear medicine scientists perform 3D SPECT imaging to visualize biodistribution and assess response immediately after treatment, allowing rapid adjustment if patients aren't benefiting.[15]

Current FDA-Approved Theranostic Agents

For Prostate Cancer:

Pluvicto (lutetium-177-PSMA-617): FDA approved in March 2022 for metastatic castration-resistant prostate cancer (mCRPC) in patients with PSMA-positive tumors who have received prior androgen receptor pathway inhibitor and taxane-based chemotherapy.[2,25] In 2025, FDA approval expanded to an earlier treatment line for PSMA-positive mCRPC patients who could delay chemotherapy.[15]

The VISION trial demonstrated a 38% improvement in overall survival and 60% reduction in risk of progression compared to standard care.[26] Lutetium-177 is a beta emitter that delivers radiation over approximately 2mm, requiring multiple particle tracks to cause sufficient DNA damage for cell death.[1,2]

Xofigo (radium-223 dichloride): An alpha emitter approved for mCRPC with symptomatic bone metastases, targeting areas of increased bone turnover.[10,27]

For Neuroendocrine Tumors:

Lutathera (lutetium-177-dotatate): FDA approved in January 2018 for gastroenteropancreatic neuroendocrine tumors (GEP-NETs) that are somatostatin receptor-positive.[3,10]

For Thyroid Cancer:

Radioiodine (I-131): The original theranostic agent, used since 1947 for differentiated thyroid cancer.[4,14]

Emerging Agents and Clinical Trials in California

Alpha Emitters: The Next Generation

Beta emitters like lutetium-177 deliver radiation over several millimeters, requiring multiple hits to tumor DNA to achieve cell death. Alpha emitters like actinium-225 and lead-212 deliver much more potent radiation over just 50-100 microns (0.05-0.1mm), causing more severe DNA damage with fewer particle tracks—described as having higher "linear energy transfer" (LET).[1,2,4]

"There are therapies called alpha emitters, which are more potent, pack a bigger punch, and may potentially have more success in treating more resistant or stubborn cancers," explains Dr. Mancini.[1]

UCSF's CD46-Targeted Alpha Therapy: Dr. Robert Flavell's group published breakthrough research in December 2024 on CD46-targeted alpha particle therapy using actinium-225.[13] This approach addresses a critical limitation: "a significant number of mCRPC patients are PSMA-negative at diagnosis or develop PSMA negativity on imaging over the course of treatment."[13] The CD46 antibody loaded with actinium-225 achieved "significant delayed growth or complete remission of tumors" in preclinical models that could not be targeted by PSMA-based therapies.[13]

UC San Diego's CONVERGE-01 Trial: UCSD is conducting a three-part study evaluating the safety and efficacy of rosopatamab tetraxetan, a PSMA-directed radioantibody conjugated to actinium-225.[28] The trial includes dose optimization and escalation phases specifically for patients who have progressed on prior lutetium-177 PSMA therapy, addressing the resistance problem with more potent alpha emission.[28]

Beyond Prostate Cancer

Dr. Mancini reports approximately 100 clinical trials investigating theranostic agents across 10-20 different tumor types, including breast cancer, pancreatic cancer, colorectal cancer, and gynecologic cancers.[1] "There's a ton of investment from an infrastructure, research, and clinical trials perspective to advancing this," he notes.[1]

UCLA's CMINT research program, co-directed by Dr. Caius Radu and Dr. Christine Mona, actively develops theranostics for multiple indications including prostate cancer, kidney cancer, and glioblastoma.[7] Dr. Mona's research specifically focuses on "reverse translation of cancer resistance mechanisms to therapy," addressing why some cancers don't respond to initial theranostic approaches.[7]

City of Hope, under Dr. Kuo's leadership, recently treated "the first breast cancer patient with an alpha-emitting radiopharmaceutical therapy at the Mayo Clinic," demonstrating expansion beyond traditional theranostic indications.[29]

Combination Therapies

Multiple California institutions are investigating combinations:

UCSD Clinical Trials include:[28]

Lutetium-177 PSMA-617 combined with standard of care vs. standard of care alone in metastatic hormone-sensitive prostate cancer
Cabozantinib + nivolumab in castration-resistant prostate cancer
Various PARP inhibitor combinations

Stanford's Research investigates whether newly diagnosed metastatic prostate cancer patients benefit from earlier Pluvicto treatment, with "promising" results according to Dr. Srinivas.[15] Stanford also studies optimal treatment cycle numbers—whether some patients would benefit from more or fewer than the standard six cycles.[15]

The Future: What's Coming in 3-5 Years

Looking ahead, Dr. Mancini anticipates several transformative developments:

More FDA-Approved Agents: Beyond the current two indications (prostate cancer and neuroendocrine tumors), additional approvals will expand access to patients with other cancers.[1]

Combination Approaches: "We'll be seeing things like combination therapies, potentially combining with immunotherapy, targeted agents, or chemotherapies, along with that theranostic agent," Dr. Mancini predicts.[1] The European Association of Nuclear Medicine (EANM) consensus highlights that "strong multidisciplinary collaboration with leadership from medical imaging specialists will be necessary" as combination regimens advance.[30]

Personalized Dosimetry Becomes Standard: Rather than fixed dosing, future protocols will feature "personalized dosing, personalized treatment schedules, and probably much larger doses than we give now, extending those treatments beyond what we give now."[1] Software advances and automated segmentation algorithms are making personalized dosimetry increasingly accessible.[20,22]

Earlier Disease Intervention: Current approvals focus on heavily pre-treated patients. Multiple phase III trials (PSMAfore, PSMAddition, SPLASH, ECLIPSE) investigate using these drugs in earlier-stage metastatic prostate cancers, "potentially opening access to a vast population of patients."[22]

Specialized Theranostic Centers: Dedicated facilities like BAMF Health, which runs 20-30 clinical trials and is "vertically integrated" to produce radiopharmaceuticals, perform imaging, and deliver treatment all on-site, represent a growing model.[1] United Theranostics, a private practice network, secured $15 million in February 2025 to build eight new centers nationwide, expanding access outside traditional academic medical centers.[26]

Enhanced Efficacy: "The therapies are going to get better. People [will] live longer with a better quality of life," Dr. Mancini projects, describing theranostics as "an additional pillar within cancer care for the years to come."[1]

Organizational Models: Lessons from California

California's major academic centers demonstrate different successful approaches to organizing theranostics:

The Independent Department Model (UCLA): Creating a standalone Department of Nuclear Medicine and Theranostics "elevates this work and strengthens UCLA's role in shaping the future of precision health," according to Dr. Czernin.[3] This model provides dedicated resources, clear leadership, and specialized infrastructure including on-site cyclotron and radiochemistry operations.[3]

The Radiology Division Model (UCSF, Stanford): Maintaining theranostics within radiology departments leverages existing imaging expertise and infrastructure while ensuring close collaboration with diagnostic nuclear medicine.[9,12,14]

The Multidisciplinary Clinic Model (UCSD): Integrating theranostics into disease-specific multidisciplinary clinics (like the Urologic Cancer Clinic) ensures seamless coordination between medical oncology, surgery, radiation oncology, and nuclear medicine, with patients receiving guidance from all specialists in a single visit.[10]

The Comprehensive Cancer Center Model (City of Hope): Embedding theranostics within a National Cancer Institute-designated comprehensive cancer center, with dedicated radiopharmacy, research infrastructure, and multidisciplinary tumor boards, enables cutting-edge clinical trials and rapid bench-to-bedside translation.[16,17,19]

Each model has strengths, suggesting that optimal organization may depend on institutional culture, existing resources, and patient population characteristics.

What Patients Should Know

For patients considering theranostic treatment:

1. Verify Eligibility: A diagnostic PET scan must confirm that your tumor expresses the molecular target (e.g., PSMA for prostate cancer, somatostatin receptors for neuroendocrine tumors) before treatment can proceed. Not all tumors express these targets.[2,30]

2. Understand the Team: Ask who will coordinate your care across nuclear medicine, radiation oncology, and medical oncology. Clear communication between specialists is essential. City of Hope's published protocols emphasize that successful theranostics requires "dedicated, multidisciplinary team of physicians, nurses and nurse practitioners, nuclear pharmacists, medical physicists, radiation health specialists and logistical support staff."[16]

3. Track Your Radiation: Request a cumulative radiation exposure summary, especially if you've had or will have EBRT or other radiation treatments. Ask whether patient-specific dosimetry calculations will guide your treatment rather than fixed standard dosing.[20,21,22]

4. Consider Clinical Trials: With approximately 100 trials underway nationally and multiple trials at California centers, eligible patients may access next-generation agents not yet FDA-approved, including alpha emitters for resistant disease.[1,28]

5. Plan for the Journey: Theranostic treatments typically involve multiple cycles (usually 4-6 for Pluvicto) spaced 6-8 weeks apart, with each infusion taking 15-30 minutes followed by radiation safety protocols.[2,8] UCLA's high-capacity center processes 80 treatments weekly, suggesting wait times may vary by institution.[8]

6. Insurance and Access: While FDA-approved agents are generally covered, confirm coverage in advance. Ask about patient navigation support—UCSD's Urologic Cancer Clinic provides dedicated patient navigators to coordinate appointments, scans, and consults.[10]

7. Location Options: California patients have access to multiple high-quality theranostics programs. Consider factors like distance from home, clinical trial availability, specialized expertise (like alpha therapy development at UCSF or combination therapy trials at UCSD), and whether the center has dedicated theranostics facilities versus shared nuclear medicine space.

8. Ask About Response Monitoring: Inquire whether your center performs post-treatment imaging (like Stanford's SPECT approach) to assess response early and adjust treatment plans.[15] Personalized monitoring may prevent continuing ineffective therapy.

Conclusion

Theranostics represents a fundamental evolution in how we approach systemic cancer treatment, merging the precision of targeted therapy with the power of internal radiation. California's academic medical centers are leading this transformation, each contributing unique expertise: UCLA's organizational innovation and large-scale capacity, UCSF's development of next-generation alpha therapies for resistant disease, Stanford's response assessment innovations, UCSD's multidisciplinary integration, and City of Hope's comprehensive research-to-practice infrastructure.

As this field matures from "infancy" toward mainstream adoption, patients benefit most when their care teams work collaboratively across specialty boundaries, maintain meticulous radiation safety oversight through patient-specific dosimetry, and stay informed about rapidly evolving clinical trial opportunities. The varying organizational models across California demonstrate that there's no single "right" way to structure theranostics programs—but all successful approaches share common elements: dedicated multidisciplinary teams, robust physics support, specialized infrastructure, and unwavering focus on radiation safety.

"It's limitless," concludes Dr. Mancini about theranostics' potential.[1] For patients navigating advanced cancer in California and beyond, this growing field offers genuine hope backed by rigorous science—provided the care delivery infrastructure, safety protocols, and team coordination keep pace with therapeutic innovation.

Verified Sources and Formal Citations

[1] Cortese, T. (2026). Theranostics in Radiation Oncology: What Is It, and Why Is It Important? Cancer Network. Retrieved from https://www.cancernetwork.com/view/theranostics-in-radiation-oncology-what-is-it-and-why-is-it-important

[2] de Faria, E. F., Barros, V. P. E., Araújo, E. B., Alonso, R., Medina, N. S., Ono, C. R., ... & Deflon, V. M. (2024). Theranostics Nuclear Medicine in Prostate Cancer. Pharmaceuticals, 17(11), 1483. https://doi.org/10.3390/ph17111483

[3] UCLA Health. (2025, November 18). UCLA Health launches Department of Nuclear Medicine and Theranostics. Retrieved from https://www.uclahealth.org/news/release/ucla-health-launches-department-nuclear-medicine-and

[4] Gafita, A., Calais, J., Grogan, T. R., Hadaschik, B., Wang, H., Weber, M., ... & Herrmann, K. (2024). Theranostics revolution in prostate cancer: Basics, clinical applications, open issues and future perspectives. Cancer Treatment Reviews, 124, 102693. https://doi.org/10.1016/j.ctrv.2024.102693

[5] UCSF Health. Radiation Oncology Program. Retrieved from https://www.ucsfhealth.org/clinics/radiation-oncology-program

[6] Stanforth Health Care. Theragnostic Care. Retrieved from https://stanfordhealthcare.org/medical-treatments/t/theragnostic-care.html

[7] UCLA Health Jonsson Comprehensive Cancer Center. Cancer Molecular Imaging, Nanotechnology and Theranostics. Retrieved from https://www.uclahealth.org/cancer/researchers/research-programs/cancer-molecular-imaging-nanotechnology-and-theranostics

[8] UCLA Health. (2023, May 17). UCLA Health to open theranostics center for personalized cancer care. Retrieved from https://www.uclahealth.org/news/article/theranostics-center-cancer-treatment

[9] UCSF Radiology. (2020, August 12). Forum for Applied Imaging Research (FAIR): Theranostics. Retrieved from https://radiology.ucsf.edu/events/forum-applied-imaging-research-fair-theranostics

[10] UC San Diego Health. High-Risk Prostate Cancer. Retrieved from https://health.ucsd.edu/care/cancer/cancers-we-treat/prostate/high-risk/

[11] Hospital Magazine. (2024, September 12). Theranostics treatments for cancer underway at UCLA Health. Retrieved from https://hospitalsmagazine.com/theranostics-treatments-for-cancer-underway-at-ucla-health2/

[12] UCSF Health. Cancer Clinical Trials and Investigational Treatments Center. Retrieved from https://www.ucsfhealth.org/clinics/cancer-clinical-trials-and-investigational-treatments-center

[13] UCSF Radiology. (2024, December 17). New Theranostic Approach Targets Prostate Cancer. Retrieved from https://radiology.ucsf.edu/blog/new-theranostic-approach-targets-prostate-cancer

[14] Stanford Medicine. (2025). A new way to see and treat cancer. Retrieved from https://med.stanford.edu/cancer/about/news/a-new-way-to-see-and-treat-cancer.html

[15] Stanford Cancer Institute. (2025, August 29). The next frontier for prostate cancer treatment. Retrieved from https://med.stanford.edu/cancer/about/news/the-next-frontier-for-prostate-cancer-treatment.html

[16] City of Hope. Los Angeles-Area Nuclear Medicine. Retrieved from https://www.cityofhope.org/locations/los-angeles/departments-and-services/diagnostic-radiology/nuclear-medicine-and-molecular-imaging

[17] City of Hope. (2025). Dr. Phillip Kuo. Retrieved from https://www.cityofhope.org/patients/find-a-doctor/phillip-kuo

[18] City of Hope. Radiopharmacy, Licensed Dispensing and Manufacturing. Retrieved from https://www.cityofhope.org/locations/los-angeles/departments-and-services/diagnostic-radiology/nuclear-medicine-and-molecular-imaging/radiopharmacy

[19] Kuo, P. H., Poku, E. K., Yamauchi, D. M., Cha, S. H., Parayno, M. L., Chong, N. E., ... & Dorff, T. B. (2025). Integration of PSMA-Targeted Theranostics into Multidisciplinary Care for Improved Efficiencies and Patient Care. Journal of Nuclear Medicine Technology, jnmt.125.270053. https://doi.org/10.2967/jnmt.125.270053

[20] Marin, I., Nicod Lalonde, M., Genitsch, V., & Wehrli, N. E. (2024). Essentials of Theranostics: A Guide for Physicians and Medical Physicists. RadioGraphics, 44(1), e230097. https://doi.org/10.1148/rg.230097

[21] Sgouros, G., Bodei, L., McDevitt, M. R., & Nedrow, J. R. (2021). Dosimetry for Radiopharmaceutical Therapy: Current Practices and Commercial Resources. Journal of Nuclear Medicine, 62(Supplement 3), 3S-11S. https://doi.org/10.2967/jnumed.121.262749

[22] MIM Software. (2025, October 22). Practical Dosimetry in Theranostics: A Guide for Resource-Constrained Clinics. Retrieved from https://go.mimsoftware.com/blog/practical-dosimetry-in-theranostics

[23] DePuey, E. G., Berman, D. S., & Cullom, S. J. (2013). Tracking patient radiation exposure: challenges to integrating nuclear medicine with other modalities. Journal of Nuclear Cardiology, 20(4), 489-492. https://doi.org/10.1007/s12350-013-9730-6

[24] Perry, D. L., Rothenberg, M. E., & Beck, H. L. (2022). Monitoring the Occupational Radiation Exposure of an Individual at Multiple Institutions. Journal of Nuclear Medicine Technology, 50(2), 161-165. https://doi.org/10.2967/jnmt.121.263277

[25] Hope, T. A., Eiber, M., Armstrong, W. R., Juarez, R., Murthy, V., Lawhn-Heath, C., ... & Fendler, W. P. (2024). Emerging Theranostics for Prostate Cancer and a Model of Prostate-specific Membrane Antigen Therapy. Radiology, 311(1), e231703. https://doi.org/10.1148/radiol.231703

[26] U.S. News & World Report. (2026, February 4). United Theranostics Expands Access to New 'Nuclear' Cancer Treatment. Retrieved from https://health.usnews.com/health-care/articles/united-theranostics-expands-access-to-new-nuclear-cancer-treatment

[27] Gandhy, R., Manudhane, A., Pucar, D., & Osborne, J. R. (2025). PSMA-Directed Theranostics in Prostate Cancer. Biomedicines, 13(8), 1837. https://doi.org/10.3390/biomedicines13081837

[28] UC San Diego Clinical Trials. UCSD Prostate Cancer Clinical Trials for 2026. Retrieved from https://clinicaltrials.ucsd.edu/prostate-cancer

[29] Kuo, P. (2024). LinkedIn post about first breast cancer patient treated with alpha-emitting radiopharmaceutical therapy. Retrieved from https://www.linkedin.com/in/phillip-kuo-24538820/

[30] Ceci, F., Oprea-Lager, D. E., Emmett, L., Adam, J. A., Bomanji, J., Czernin, J., ... & Fanti, S. (2023). European Association of Nuclear Medicine Focus 5: Consensus on Molecular Imaging and Theranostics in Prostate Cancer. European Urology, 85(1), 49-60. https://doi.org/10.1016/j.eururo.2023.09.001

About This Article: This article was prepared for the Informed Prostate Cancer Support Group (IPCSG) newsletter to help patients understand theranostics, its role in modern cancer care, the importance of integrated team approaches for tracking radiation exposure, and how major California cancer centers are implementing these programs. Information is current as of February 2026.

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