The use of Ac in prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT), either as monotherapy or in combination with Lu, is a promising therapy approach in patients with metastatic castration-resistant prostate carcinoma (mCRPC). In this study, we report the efficacy and safety of [Ac]Ac-PSMA-617 augmented [Lu]Lu-PSMA-617 RLT in Lu-naive mCRPC patients ( = 15) with poor prognosis (presence of visceral metastases, high total tumor burden with diffuse bone metastases or a short PSA doubling time of <2 months). Biochemical (by PSA serum value) and molecular imaging response (by [Ga]Ga-PSMA-11 PET/CT) was assessed after two cycles of [Lu]Lu-PSMA-617 RLT, with at least one [Ac]Ac-PSMA-617 augmentation.
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