Radioligand Therapy Side Effects and How to Manage Them
CancerProstate Cancer

Side Effects of Radioligand Therapy for Metastatic Prostate Cancer and How to Manage Them

Side Effects of Radioligand Therapy for Metastatic Prostate Cancer and How to Manage Them
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Published on September 28, 2026
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Radioligand therapy is a type of targeted treatment for metastatic prostate cancer (cancer that has spread beyond the prostate) that attacks cancer cells anywhere in the body while minimizing harm to healthy tissue. Like any cancer treatment, radioligand therapy can cause side effects. While common, rest assured that these side effects are typically mild, temporary, and manageable with proactive care and support from your care team.

“What can happen week one [after treatment] is, most commonly, fatigue, dry mouth, gastrointestinal issues like nausea, vomiting, diarrhea, and constipation, and pain,” says Scott Tagawa, MD, a professor of medicine and urology at Weill Cornell Medicine in New York City. “If any of that is going to happen, it's usually on day one, day two, or in the first week, and then it gets better with time.”

Common Side Effects

Radioligand therapy for prostate cancer is also called PSMA therapy because it targets prostate-specific membrane antigen (PSMA), a type of protein found in large amounts on the surface of up to 90 percent of prostate cancer cells.

 But PSMA is also found in smaller quantities on various other tissues in the body, such as the small intestines, liver, kidneys, and salivary glands.

 Most of the side effects from the treatment occur because the medication, lutetium Lu-177 vipivotide tetraxetan (Pluvicto), has attached to and damaged these normal tissues.

“Generally, this is a very well-tolerated treatment with limited side effects in most patients,” says Amir Iravani, MD, a nuclear medicine physician with UCLA in Los Angeles.

When side effects do occur, they can include the following.

Dry Mouth

Dry mouth is one of the most common side effects of PSMA therapy, affecting at least 4 in 10 patients.

 It occurs because the salivary glands are “a place where this medication also binds to and releases the radiation,” says Daniel Sentana, MD, a medical oncologist with the Dana-Farber Cancer Institute in Boston. Usually, the side effect is mild but in some cases it can make it difficult for people to eat and drink comfortably, he says.
Some recommended management strategies for dry mouth to keep your saliva flowing include:

  • Sodium bicarbonate (baking soda) mouthwash
  • Good hydration and regularly sipping water
  • Saliva gels or lubricants
  • Sugarless hard candies or gum
  • Dry mouth medications like pilocarpine

“This dry mouth tends to get better over time, but it's not necessarily something that will,” Sentana says. “Once you start the treatment, it may take a long time to go away.”

Fatigue

Fatigue is about as common as dry mouth for people undergoing radioligand treatment for prostate cancer.

“Patients feel tired, especially in the next few days after treatment, and then it usually improves,” Dr. Iravani says, adding that the side effect is mild, and most prostate cancer patients already experience fatigue from other treatments like hormone therapy.

Get adequate rest, pace yourself during activities, engage in daily physical exercise, and lower your stress levels (such as through yoga and meditation) to manage your energy levels between and after treatments.

 If necessary, your provider may also prescribe stimulant medications like methylphenidate (Ritalin, Concerta) to combat fatigue.

Gastrointestinal Issues

Roughly a third of patients experience nausea from the treatment. Other gastrointestinal issues, including constipation, vomiting, diarrhea, and decreased appetite, are also common.

You may be given anti-nausea medication right before your infusion to help prevent nausea.

 If you do still experience nausea, it’ll typically happen on the day of or the day after treatment and can last a few more days, Iravani says. “It's generally self-limiting, and it's resolved by just taking over-the-counter or prescription anti-nausea medications,” he says.
To help with nausea and vomiting, you can also try eating smaller, more frequent meals consisting of room-temperature foods and drinks. Frequent meals, especially those high in calories and proteins, can also help with appetite issues, and you can try to make your food more palatable or tasty with sauces and spices.

Dietary fiber can relieve both constipation and diarrhea.

 Stick to insoluble fiber — found in beans, nuts, whole wheat, and vegetables like cauliflower, green beans, and potatoes — for constipation, and soluble fiber — found in apples, oats, bananas, carrots, and peas — for diarrhea.

 Antidiarrheal medications can also relieve loose stools.

Bone Pain

Talk with your healthcare provider if you experience bone pain, which may affect about 1 in 9 people undergoing PSMA therapy, typically during the first week after treatment. They may prescribe anti-inflammatory drugs like dexamethasone, opioids, or other pain relievers.

Less Common or Serious Side Effects

Some side effects, which can be serious, don’t cause obvious symptoms at first and are instead caught through routine blood work, Dr. Tagawa notes. “That's why we typically will check blood tests between the treatments,” he says.

One side effect is kidney toxicity, Iravani notes, as the kidneys have cells that express PSMA, which the radiation can also attack. “Patients who have good renal function to begin with generally don't have much of a problem,” he says. “It's more the patients who have borderline or already impaired renal function, or may have other comorbidities, like diabetes and hypertension.”

Signs of kidney dysfunction include increased fatigue, itchy skin, and urination problems like frequent urination, bloody urine, and foamy urine.

“A second, relatively common phenomenon is a decrease in blood counts,” Tagawa says. “It is usually not severe — some decrease from the baseline — and that is something that is typically noticed three to four weeks later.”

This occurs because bone marrow, which produces blood cells, can also receive some radiation, Sentana says. And while this can lower all types of blood cells, “the ones that seem to be most affected are red blood cells and platelets.”

Some signs your blood counts may be dropping include:

  • Increased fatigue
  • Shortness of breath
  • Dizziness
  • Easy bruising or bleeding
  • Fever and chills
  • Swollen lymph nodes
  • Sore throat

When to Call Your Care Team

Side effects from PSMA therapy should never be suffered through in silence, and it’s important to maintain open communication with your care team. “Patients need to make sure they're seeing a doctor in between treatments,” Tagawa says. “This is a type of therapy that really needs what we call a multidisciplinary approach.”

Call your care team immediately if you have symptoms of kidney dysfunction or low blood counts, or if you experience:

  • Uncontrolled nausea or vomiting
  • Lasting appetite loss or rapid weight loss
  • Constipation that lasts three or more days
  • Decreased or very dark urine
  • Bone pain that doesn’t go away
  • Signs of liver issues like jaundice (yellowing of the skin or eyes), pale bowel movements, and abdominal pain
  • Infusion-site reactions like pain, redness, swelling, blisters, or numbness or tingling

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
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