Prostate-specific membrane antigen (PSMA) labelled with radioisotopes has changed the management of prostate cancer. Position emission tomography (PET) using either Gallium-68 or Fluorine-18 conjugated with PSMA detects tumor recurrence at low level of prostate specific antigen. The strongest evidence came from a large scale randomized control trial (RCT) published at Lancet in 2020 (proPSMA). When tumors are detected by PET showing overexpression of PSMA, PSMA labelled with Lutetium-177 kills them by DNA breakdown, and it is called “theranostics”. Two RCT published in 2021 (Lancet, TheraP; NEJM, vision) proved that 177Lu-PSMA are effective and safe in treating patients with metastatic castration-resistant prostate cancer. Now we are able to fight against prostate cancer with magic bullet, instead of old fashion way of try-and-error. Unfortunately, while PSMA theranostics is ongoing world widely and is addressed in NCCN guideline, we are not able to perform routinely in Taiwan. The key point may be national regulation and market size. Moreover, approximately 10-15% of tumors showing PSMA overexpression have no response to 177Lu-PSMA therapy. Target alpha therapy using PSMA labelled with Actinium-225 showed promising results in patients resistant to beta therapy. Again, we are far away from this currently or in near future. In this topic I am going to talk about the difference between Taiwan and other countries, the difficulties, and the solutions, in PSMA theranostics.