Could custom doses of prostate cancer radiation be safer and stronger?

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: 1. Patient aged ≥18 years with metastatic adenocarcinoma of the prostate, defined by documented histopathology of prostate adenocarcinoma; 2. Castration-resistant prostate cancer, as defined as disease progressing despite castration by orchiectomy or ongoing androgen deprivation therapy; 3. Progressive mCRPC with rising PSA level, defined by PCWG3 criteria (sequence of two rising values above a baseline at a minimum of 1-week intervals, with serum testosterone level ≤ 1.7 nmol/dL); 4. PSA ≥2 ng/mL ; 5. Prior treatment with at least one ARPI; 6. PSMA-expressing cancer, with significant PSMA expression defined as SUVpeak in at least one lesion that is superior to SUVmean of the liver on PSMA-PET (68Ga-PSMA-11 or 18F-DCFPyL), within 45 days prior to randomization; 7. ECOG Performance status 0 to 2; 8. Calculated eGFR (by CKD-EPI formula) ≥ 45 mL/min/1.73m\^2; 9. Albumin ≥ 25 g/L; 10. Platelets ≥ 100x10\^9/L; 11. Neutrophils ≥ 1.5x10\^9/L; 12. Hemoglobin ≥ 90 g/L without transfusion in the past 4 weeks; 13. Signed, written informed consent Exclusion Criteria: 1. PSMA-PET "superscan" (i.e. extensive/diffuse PSMA-positive bone involvement); 2. Site(s) of disease that are FDG-positive, defined as SUVpeak in at least one lesion that is superior to twice (2x) SUVmean of the liver, and PSMA-negative (as above), within 45 days prior to randomization; 3. Prior treatment with more than two lines of chemotherapy for mHSPC and/or mCRPC (adjuvant and neoadjuvant chemotherapy does not count) towards the maximum of two regimens); 4. Prior radiopharmaceutical therapy; 5. Known CNS metastasis unless they are deemed to be non-progressive, asymptomatic and off corticosteroid therapy for at least four weeks, as per investigator's assessment; 6. Active malignancy other than prostate cancer; 7. Patients who are sexually active and not willing/able to use medically acceptable forms of barrier contraception; 8. Any other condition, diagnosis or finding that may in the investigator's opinion interfere with trial conduct; 9. Known hypersensitivity to 177Lu-PSMA-617 or to any ingredient in the formulation, including any non-medicinal ingredient, or component of the container.