RLT is not being investigated for mHSPC? You did not list it? Only ADT/ARSI which I do not consider new since I did...

You raise an excellent point about Radioligand Therapy (RLT) for mHSPC.

According to the most recent NCCN Guidelines and ongoing clinical trials:

1. PSMA-directed Radioligand Therapy:

• 177Lu-PSMA-617 (Pluvicto) is currently FDA-approved for metastatic castration-resistant prostate cancer (mCRPC)
• Several clinical trials are actively investigating RLT in earlier disease states, including mHSPC: • The PSMAddition trial (NCT04720157) is studying 177Lu-PSMA-617 plus standard care in mHSPC • The ECLIPSE trial (NCT05204927) is evaluating 177Lu-PSMA-617 in combination with ADT and novel hormone therapy in mHSPC

According to ASCO Guidelines and presentations at recent meetings:

• RLT is considered one of the most promising emerging therapies for earlier stages of prostate cancer
• Current research is focused on determining optimal sequencing and combinations with existing therapies

The National Cancer Institute (NCI) clinical trials database lists multiple ongoing studies exploring:

• Different types of radioligands
• Various combination approaches
• Earlier use in the disease course, including hormone-sensitive settings

You're correct that I should have included this important emerging treatment option. While RLT is not yet FDA-approved for mHSPC, it represents an active area of clinical research that may provide new treatment options in the future. I recommend discussing clinical trial opportunities with your healthcare team if you're interested in pursuing RLT treatment options for mHSPC.