Theranostics is one of those ideas that may sound almost unreal at first: a single molecule capable of both finding cancer and killing it. This is not just a theoretical idea or something seen in a lab; it is being implemented in real clinical practice.
Over the past decade, this approach has significantly transformed the treatment of advanced prostate cancer. And Germany has become one of the places where it’s used most consistently and with the most experience.
This article explains what theranostics is, why it matters now, and how Germany has made Lutetium‑177 PSMA therapy routine in cancer care. It also explains how the treatment works, what makes German centers unique, and what patients should know before booking treatment in Germany.
The Core Idea: One Molecule, Two Jobs
Theranostics is built on a straightforward concept: use one targeted molecule to both locate cancer and treat it. In prostate cancer, the target is PSMA — a protein that tumor cells display on their surface much more actively than healthy tissue. This makes PSMA a reliable marker, something the cancer can’t easily hide.
The theranostic molecule is designed to bind to PSMA wherever it is found in the body. When used with a tracer, it shows cancer cells on a PSMA PET/CT scan. When paired with a therapeutic isotope such as Lutetium‑177, it delivers radiation directly to cancer cells.
This single tool effectively performs both tasks: it first identifies the disease via imaging. Then it delivers treatment to the previously mapped locations.
This is the basis of Lutetium-177 PSMA therapy in Germany. Instead of exposing the entire body to radiation or chemotherapy, treatment focuses on the cancer itself.
As a result, healthy tissues receive much less exposure, and therapy can reach the disease that has spread to bones, lymph nodes, or distant organs.
Why Germany Became the Global Center of Theranostics
Germany became a theranostics leader by adopting PSMA PET/CT early and building the infrastructure around it long before most countries — radiopharmacies, protected treatment rooms, and teams trained to handle therapeutic isotopes.
By the time Lutetium‑177 PSMA therapy gained international recognition, German clinics already had years of routine experience. According to the German Society of Nuclear Medicine, more than 7,000 PSMA‑targeted treatments were performed between 2015 and 2022, one of the highest volumes worldwide.
The country also built a radiopharmaceutical ecosystem that keeps the process running smoothly. Germany operates 32 clinical cyclotrons, giving it one of the strongest local isotope supply chains in Europe. Diagnostic capacity expanded in parallel: national PET data show a 48% increase in PET volume from 2017 to 2021, reflecting an active and growing clinical infrastructure.
For patients, this means the therapy is not experimental. It is standard clinical practice delivered by teams who perform these procedures every week. The system also efficiently evaluates international patients. Not everyone is accepted — selection is strict — but when a patient is eligible, the process is clear and predictable.
Why This Therapy Helps Some Patients More Than Others
Lutetium‑177 PSMA therapy is effective only when the cancer shows strong PSMA uptake on a PET/CT scan. If the tumor lights up clearly on the scan, the treatment will have a reliable target. However, if the uptake is weak or uneven, reputable medical centers typically will not proceed with the treatment, as the molecule would lack a stable target to bind to.
Kidney function and bone marrow reserve play an important role in treatment outcomes, as the body needs to clear the isotope and recover between treatment cycles.
A 2022 analysis published in Lancet Oncology found that men with high PSMA expression experienced approximately twice the progression-free survival compared to those with low PSMA PSMA uptake. When the biology is favorable, the therapy can effectively slow the disease; when it isn’t, administering the treatment is not medically justified.
How Lutetium‑177 PSMA Therapy Actually Works
After the patient has been confirmed as a suitable candidate for therapy, the Luteinum-177 compound is injected into the vein. This compound circulates throughout the body and is attached to cancer cells that are positive for PSMA, which may be in bones, lymph nodes, or removed organs. The radiation emitted by lutetium-177 spreads for just a few millimeters, effectively destroying tumors and minimizing damage to healthy tissue.
On the day of the procedure, patients have a brief blood test and receive an injection in a controlled environment. After the procedure, they will remain for a short observation period. Most patients can eat, walk, and rest normally afterward, though fatigue is the most common side effect.
The therapy is typically administered every six to eight weeks. Between cycles, lab tests and imaging are conducted to monitor kidney function, bone marrow tolerance, and treatment response.
The benefits of this therapy are well-documented. According to the VISION trial, adding Lutetium-177 PSMA to standard care resulted in a 38% improvement in overall survival. Most patients tolerate this treatment better than chemotherapy. While fatigue and dry mouth are common side effects, serious complications are rare. For patients with advanced prostate cancer, this therapy represents the first significant option in years that can meaningfully slow the progression of the disease.
Leading Theranostics Doctors and Clinics in Germany
Germany’s strength in theranostics stems from a handful of centers that treat these patients weekly and publish much of the research that has shaped today’s PSMA protocols. We obtained the following data from the Airomedical health platform, which kindly shared the ranking and nuclear medicine physicians and top clinics in Germany.
Heidelberg remains the scientific anchor — it is where PSMA‑617 was first developed, and Prof. Uwe Haberkorn’s team continues to run one of the highest‑volume nuclear medicine programs in Europe.
In Munich, the team at Rechts der Isar, led by Prof. Matthias Eiber, combines advanced imaging expertise with a robust theranostics research program. Essen, under the direction of Prof. Ken Herrmann, and Saarland Homburg, led by Prof. Samer Ezziddin, offer established Lu-177 services, ensuring a well-coordinated process from PET imaging to therapy. LMU Munich, under the guidance of Prof. Rudolf Alexander Werner, offers another high-volume academic program.
In addition to these university hospitals, several private centers have developed Lu-177 programs. Helios Berlin-Buch, led by Professor Stefan Dressel, provides clear patient care pathways and is included in international physician search lists. Meanwhile, Vivantes Neukölln operates a specialized radionuclide therapy department with the option of inpatient treatment in a single room.
How to Choose the Right Clinic
For most patients, the real task is not finding a “famous” hospital but identifying a clinic that fits their specific case. While German medical centers adhere to the same medical principles, their protocols can vary significantly. Some may require both dual-tracer PSMA and FDG scans, while others accept PSMA PET scans alone.
Additionally, some facilities administer Lu-177 treatments on an outpatient basis, while others prefer inpatient stays. There are also differences in dose adjustment rules, tumor board routines, and cost structures. As a result, selecting the appropriate protocol often takes precedence over choosing the most well-known facility, especially if you plan to book treatment in Germany and want a predictable process from the beginning.
This is where the Airomedical platform is helpful. It is a medical navigation service that verifies which clinics actually perform Lu‑177 PSMA therapy, how frequently they treat, and whether their processes meet expected standards. Their ranking model is based on verifiable data, including physician experience, accreditation, workflow maturity, and safety indicators. UserScore enhances credibility by incorporating weighted patient feedback.
For patients, this ranking system highlights centers where theranostics is a routine practice, and helps them take the first step in the right direction.
What Patients Should Prepare Before Coming to Germany
German facilities conduct quick reviews of cases as soon as the medical documentation is completed. Important documents include recent PSMA PET/CT (no older than 8-12 weeks), pathological reports, summaries of previous treatments, and updated blood tests.
Delays may occur if the images are outdated, missing, or sent without an accompanying report. To make planning your visit easier, it is best to send all documents together, preferably in English and in a single package, to avoid unnecessary communication.
The Future of Theranostics
German centers conduct quick reviews of cases as soon as the medical documentation is completed. Important documents include recent PSMA PET/CT (no older than 8-12 weeks), pathological reports, summaries of previous treatments, and updated blood tests.
Delays may occur if the images are outdated, missing, or sent without an accompanying report.
To make planning your visit easier, it is best to send all documents together, preferably in English and in a single package, to avoid unnecessary communication.
FAQ
How do doctors confirm my eligibility for Lutetium‑177 PSMA therapy?
Eligibility depends on a recent PSMA PET/CT showing clear uptake, as the therapy requires a reliable target.
Is the treatment inpatient or outpatient in Germany?
Some hospitals administer Lutetium-177 treatment on an inpatient basis for radiation safety reasons. However, imaging and follow-up appointments are typically done on an outpatient basis. A few centers may offer day-case therapy.
How many treatment cycles should I expect?
Most patients can expect to receive an injection approximately every 6 weeks, with lab tests and imaging between cycles. The total number of treatment cycles will depend on how well the treatment is tolerated and the patient’s response.
How can I choose the right clinic if protocols differ?
Protocols vary across hospitals, including eligibility criteria, and pricing. The Airomedical platform helps navigate these differences by confirming which clinics have established theranostics programs.
References
- Hofman, M.S. et al. Lu‑PSMA‑617 for metastatic castration‑resistant prostate cancer (VISION trial). New England Journal of Medicine. 2021.
- Dr. Ahmed F. Lutetium-177 PSMA Prostate Cancer Treatment in Germany. Airomedical. 2026.
- Bundesamt für Strahlenschutz (BfS). National PET/CT utilization report 2017–2021. 2022.
- Mudr. Popel Angelina, Dr. Volvak Marta. Top Nuclear Medicine Theranostics Teams in Germany. Airomedical. 2026.
- German Society of Nuclear Medicine (DGN). National registry report on PSMA‑targeted therapies in Germany, 2015–2022. 2023.
- Haberkorn, U., Eiber, M., Herrmann, K., Ezziddin, S. Clinical implementation and development of PSMA‑targeted theranostics. Journal of Nuclear Medicine / European Journal of Nuclear Medicine and Molecular Imaging. 2020–2024.
