Türkiye has taken a major step forward in the treatment of advanced prostate cancer by introducing reimbursement for Actinium-225 (Ac-225) PSMA radioligand therapy under the national Social Security Institution (SGK) reimbursement system.

The new regulation, incorporated into the Health Implementation Communiqué (SUT), establishes Ac-225 PSMA as a reimbursable radionuclide therapy for eligible patients treated at authorized tertiary public healthcare institutions. This milestone significantly improves
patient access to one of the most innovative targeted alpha therapies currently available for metastatic castration-resistant prostate cancer (mCRPC).

A Milestone in Precision Oncology

Actinium-225 PSMA therapy is a highly targeted radiopharmaceutical treatment that delivers alpha-particle radiation directly to prostate cancer cells expressing the Prostate-Specific Membrane Antigen (PSMA). Owing to the short tissue range and high linear energy transfer
of alpha particles, the treatment can induce potent tumor cell destruction while minimizing radiation exposure to surrounding healthy tissues.

Growing clinical evidence has demonstrated promising therapeutic efficacy, particularly in patients whose disease has progressed despite conventional systemic therapies and Lutetium-177 PSMA treatment.

Reimbursement Criteria

• According to the updated SUT provisions, reimbursement applies under the following conditions:
• Treatment must be performed in tertiary-level public healthcare institutions.
• Patients must have metastatic castration-resistant prostate adenocarcinoma with documented disease progression.
• A multidisciplinary medical board report, including specialists in Nuclear Medicine and Medical Oncology, is required.
• Patients should have received standard systemic therapies, including taxane chemotherapy and at least one next-generation androgen receptor pathway inhibitor.
• Patients must have experienced disease progression following at least two cycles of Lu-177 PSMA therapy or have shown no response after four treatment cycles.
• Ga-68 PSMA PET/CT demonstrating sufficient PSMA-positive disease is mandatory before treatment.
• Therapy may be administered at intervals of at least six weeks for a maximum of four treatment cycles.

Improving Access to Innovative Care

The reimbursement decision is expected to:

• Improve equitable access to advanced radioligand therapy,
• Reduce the financial burden on eligible patients,
• Support the broader implementation of precision oncology within Türkiye,
• Strengthen the country's position among nations offering state-supported targeted alpha therapy.

A New Era for Nuclear Medicine in Türkiye

The inclusion of Ac-225 PSMA therapy in the national reimbursement framework represents an important advancement for nuclear medicine and personalized cancer care. As targeted alpha therapies continue to reshape the therapeutic landscape of metastatic prostate cancer,
this decision demonstrates Türkiye's commitment to providing patients with access to cutting-edge, evidence-based treatments.