Radiotheranostics in Low- and Middle-Income Countries: Challenges, Practice, and Prospects.

There is a global rise in the number of new cancer diagnoses and cancer deaths. Rising new cancer diagnoses and deaths from low- and middle-income countries (LMICs) are the biggest contributors to this global trend. Efforts geared toward prevention, timely diagnosis, effective treatment, and efficient cancer survivorship programs are needed to address the rising scourge of cancer in LMICs. Radiotheranostics entails using radiopharmaceuticals for diagnostic imaging and therapy of diseases. Functional imaging, as in radiotheranostics, is more sensitive for disease detection and treatment response assessment than conventional cross-sectional imaging. Therefore, radiotheranostics has the potential to address some of the strategies to curtail the rising scourge of cancer and its mortality in LMICs, including timely diagnosis, effective management, and disease surveillance. Many key issues hinder the widespread availability, access, and utilization of nuclear medicine (NM) and radiotheranostics services in LMICs. These issues include scarcity of trained (NM) professionals, lack of training for (NM) personnel, poor infrastructure, inadequate awareness of NM and radiotheranostics, poor funding, and poorly conceived regulations that stifle NM practice. Despite these hindrances, many success stories have emerged from LMICs regarding clinical application of radiotheranostics. For example, many practice-defining studies have been published by groups from LMICs regarding prostate-specific membrane antigen-targeted imaging and therapy of prostate cancer. Specifically, notable contributions have been made to the literature by groups from South Africa, India, and Türkiye on the safety and efficacy of 225Ac-PSMA-617 for therapy of advanced prostate cancer. Through the intervention of many international organizations, governments, and private sectors, there has been a steady improvement in the awareness, availability, access, and utilization of NM and radiotheranostics services in LMICs.