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Radiopharmaceutical therapy - see it, then treat it.

Targeted radioligand treatment - Lu-177 PSMA for prostate cancer, Lu-177 DOTATATE for neuroendocrine tumours, Ra-223 for bone metastases and I-131 MIBG. Delivered by an ARSAC-certificated nuclear medicine physician, with a paired diagnostic PET before every isotope.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What a private cycle costs in the UK.

Indicative ranges across our nuclear medicine partners.

In short

£22,000–£35,000, home the same day.

Therapy Indicative range
Lu-177 PSMA cycle (metastatic prostate cancer) £22,000–£35,000
Lu-177 DOTATATE cycle (neuroendocrine tumour) £20,000–£30,000
Ra-223 dichloride cycle (bone-only prostate mets) £5,500–£9,000
I-131 MIBG therapy (phaeochromocytoma, paraganglioma, neuroblastoma) £18,000–£30,000
PSMA PET/CT staging scan £1,900–£2,600
Ga-68 DOTATATE PET/CT staging scan £2,100–£2,900
Theranostics MDT consultation only £350–£600

Prices vary by isotope, by centre, and by how many cycles are prescribed. Lu-177 preparations are the most expensive because the isotope is manufactured to order and shipped for a fixed slot.

The problem

The right isotope, in the right patient, at the right time.

Radiopharmaceutical therapy is where UK oncology quietly loses patients - either to a waiting list, or to a cycle started without the PET evidence to back it up. We fix both.

  • PET first, isotope second

    Every cycle needs a paired diagnostic PET - PSMA for Lu-177 PSMA, Ga-68 DOTATATE for Lu-177 DOTATATE, I-123 MIBG for I-131 MIBG. If the tumour does not light up, the isotope will not treat it.

  • A theranostics MDT decides

    A nuclear medicine physician, a medical oncologist and a radiopharmacy in the same conversation - not one specialist trying to sign it off alone.

  • Cycles, not one-offs

    A course is four to six cycles across five to nine months. We plan the calendar, the bloods and the interim scans so nothing is missed.

When it helps

When a radioligand is the right treatment.

The clinical situations we see most, and the two red flags that mean acute cancer care today rather than a theranostics referral next week.

  • Metastatic castration-resistant prostate cancer

    PSMA-avid disease after docetaxel and a novel hormonal agent - the licensed setting for Lu-177 PSMA-617 (Pluvicto).

  • Progressive, well-differentiated NETs

    Grade 1 or 2 gastroenteropancreatic neuroendocrine tumours that are somatostatin-receptor positive on Ga-68 DOTATATE PET.

  • Symptomatic bone metastases in prostate cancer

    Painful, bone-predominant metastatic prostate cancer without visceral spread - the niche for Ra-223 (Xofigo), an alpha emitter.

  • MIBG-avid phaeo or paraganglioma

    Metastatic or unresectable phaeochromocytoma, paraganglioma or high-risk neuroblastoma that lights up on a diagnostic I-123 MIBG scan.

  • Progression after first-line systemic therapy

    Rising markers or new lesions after standard chemotherapy or hormonal treatment - where a targeted radioligand offers a fresh mechanism.

  • Adequate marrow, kidney and liver function

    Neutrophils above 1.5, platelets above 100, GFR above 50, bilirubin within limits - the numbers every theranostics unit checks first.

  • A carer at home for a few days

    Not medically essential, but the release-criteria advice is easier when someone else can do the school run and share the kitchen for a week.

  • Red flag: cord compression or hypercalcaemia

    New back pain with leg weakness, or confusion with a very high calcium, is an emergency - A&E first, theranostics second.

Therapy options

The isotope, and the biology it treats.

Each radioligand pairs a targeting molecule with an alpha or beta emitter. The isotope is chosen to match the receptor, the tumour size and the marrow reserve.

  • Lu-177 PSMA-617 (Pluvicto)

    A beta-emitting radioligand that binds the PSMA receptor on prostate cancer cells. Four to six cycles, 6–8 weeks apart. Modest, manageable side effects - dry mouth, mild marrow suppression, fatigue.

  • Lu-177 DOTATATE (Lutathera)

    A beta-emitting radioligand that binds somatostatin receptor 2 on NET cells. Four cycles at 8-week intervals with mandatory amino-acid renal protection during the infusion.

  • Ra-223 dichloride (Xofigo)

    A calcium-mimetic alpha emitter that homes to areas of high bone turnover. Six monthly injections. Bone-only metastatic prostate cancer, not for visceral disease.

  • I-131 MIBG

    A high-dose targeted radiotherapy for MIBG-avid neural-crest tumours. Given as a single or repeated inpatient dose with 3–5 nights in a lead-shielded room.

  • Alpha vs beta emitters

    Alpha particles (Ra-223, and emerging Ac-225 PSMA) deposit huge energy over microns - powerful, marrow-sparing. Beta particles (Lu-177, I-131) travel millimetres and treat clusters of cells.

  • Emerging: Ac-225 PSMA

    An actinium-225 alpha-labelled PSMA ligand for patients who progress after Lu-177. Trial and named-patient access in the UK - we say when it is genuinely on the table.

  • Emerging: FAP-targeted radioligands

    Fibroblast activation protein ligands (FAPI) for sarcomas, pancreatic and other stromal-rich tumours. Investigational in the UK, occasional named-patient routes.

  • Peptide receptor radionuclide therapy (PRRT)

    The umbrella name for somatostatin-receptor targeted therapies - Lu-177 DOTATATE is the licensed workhorse in the UK.

Safety and side effects

What a cycle actually feels like - honestly.

Radioligand therapy is well tolerated for most patients. The things worth planning are the marrow bloods, the kidney protection, the radiation-safety week at home and the airport card.

  • A cannula, an infusion, and a scanner afterwards

    For Lu-177 the isotope is given by slow injection or infusion over 20–40 minutes.

  • Dry mouth, nausea and fatigue

    Dry mouth is the most-reported side effect of Lu-177 PSMA (about a third of patients). Nausea and fatigue are common with all four therapies and settle in a week or two.

  • Marrow suppression is the one to watch

    Neutrophils, platelets and haemoglobin all fall gradually across cycles. Bloods every two weeks are non-negotiable - a cycle is delayed, never rushed, if counts have not recovered.

  • Kidney protection for Lu-177 DOTATATE

    A four-hour amino-acid infusion runs alongside the isotope to protect the tubules. It causes nausea in most patients - a strong anti-emetic is standard.

  • Radiation safety at home for 3–7 days

    Sleep alone, keep young children and pregnant contacts at arm’s length, flush the toilet twice and wash your hands. The nuclear medicine team writes it down for you.

  • Ra-223 is bone-only

    Adding Ra-223 to abiraterone increased fractures in a large trial - it is now used as a single agent in bone-predominant disease without visceral spread.

  • A small long-term MDS/AML risk

    Any radioligand carries a low, cumulative risk of secondary blood cancers years later. It is small compared with the benefit for advanced disease - but it is real, and we discuss it before cycle one.

  • Travel and airport radiation detectors

    You can set off airport monitors for weeks after treatment. The unit gives you a signed card that explains the isotope, dose and date to show at security.

  • Red flags between cycles

    Fever with a low count, breathlessness, uncontrolled vomiting, new severe bone pain or bleeding - call the unit’s 24-hour line or attend A&E, not a routine review.

Reading your treatment note

Your theranostics note in four parts. Read the last one first.

Whichever isotope was used - Lu-177 PSMA, Lu-177 DOTATATE, Ra-223 or I-131 MIBG - the report the nuclear medicine team sends you keeps to the same shape.

A UK consultant nuclear medicine physician reviewing a post-therapy SPECT/CT

A quiet reminder

Dosimetry language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the post-therapy SPECT and the marker trend before your review, just ask.

  1. 01 Uptake

    PSMA / DOTATATE / MIBG avidity

    The diagnostic PET or MIBG scan sets the whole treatment plan - how bright the tumour is, and whether every deposit lights up or only some.

  2. 02 Dosimetry

    Absorbed dose to tumour and organs

    The post-therapy SPECT/CT estimates how much radiation reached the tumour and the doses reaching kidneys, marrow and salivary glands.

  3. 03 Response

    Marker, imaging and symptom trend

    PSA for PSMA, chromogranin A and 5-HIAA for NETs, pain score for Ra-223 - read alongside interval PET rather than in isolation.

  4. 04 Impression

    Continue, pause or switch

    Read this first: whether to proceed to the next cycle, wait for counts to recover, or move to a different systemic option.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Lu-177 PSMA, Lu-177 DOTATATE and Ra-223 are usually covered when clinically indicated and licensed. Off-label and named-patient routes need pre-authorisation.

Frequently asked

Everything we get asked about radiopharmaceutical therapy.

Quick answers on eligibility, cycles, side effects, cost and radiation-safety at home.

  • What is radiopharmaceutical therapy - and why is it called theranostics?

    Radiopharmaceutical therapy uses a small molecule tagged with a radioactive isotope that binds a receptor on tumour cells and delivers radiation from the inside. Theranostics means the same targeting molecule is available with a diagnostic isotope (for PET imaging) and a therapeutic isotope (for treatment) - see it, then treat it.

  • Am I eligible for Lu-177 PSMA (Pluvicto)?

    Broadly: metastatic castration-resistant prostate cancer that has progressed after docetaxel and a novel hormonal agent (abiraterone or enzalutamide), with PSMA-avid disease on PSMA PET/CT and adequate kidney, liver and marrow function. NICE has recommended it on the NHS in this setting, though access varies by centre and there is a waiting list - private routes give a shorter timeline.

  • What does a cycle of Lu-177 DOTATATE actually involve?

    A day case in the nuclear medicine unit. A cannula, a strong anti-emetic, a four-hour amino-acid infusion to protect your kidneys running alongside the isotope, and post-therapy imaging. Home the same day with written radiation-safety advice for a week. Four cycles eight weeks apart is standard.

  • How is Ra-223 different from the Lu-177 treatments?

    Ra-223 is an alpha emitter that mimics calcium and homes to areas of high bone turnover - so it treats bone metastases specifically. It is a quick injection rather than a long infusion, side effects are usually milder, but it is not suitable if there is significant disease in the lymph nodes, liver or lungs.

  • How much does a course cost privately in the UK?

    Roughly £22,000–£35,000 per Lu-177 PSMA cycle, £20,000–£30,000 per Lu-177 DOTATATE cycle, £5,500–£9,000 per Ra-223 injection, and £18,000–£30,000 for an I-131 MIBG admission. A full course of four to six cycles runs from about £30,000 (Ra-223) to over £150,000 (Lu-177 PSMA).

  • Do I have to stay in hospital?

    For Lu-177 PSMA, Lu-177 DOTATATE and Ra-223 in the UK, no - it is a day case and you go home the same evening with safety instructions. I-131 MIBG is different - it needs 3–5 nights in a lead-shielded single room while the highest activity clears.

  • What are the radiation-safety rules at home?

    For 3–7 days after Lu-177 or Ra-223: sleep alone, keep pregnant women and young children at least a metre away, use one bathroom you can flush twice, wash your hands well and wash clothes and bedding separately if soiled. The unit gives you a written sheet and a signed travel card. I-131 MIBG restrictions are stricter and longer.

  • What is the difference between alpha and beta emitters?

    Alpha particles (Ra-223, actinium-225) are heavy and deposit huge energy over just a few cell diameters - very powerful, more marrow-sparing, hard to shield only because they cannot escape the body. Beta particles (Lu-177, I-131) are lighter and travel a few millimetres, treating clusters of cells and offering a small crossfire effect. The isotope is chosen to fit the tumour.

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