Abstract <p>Prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT) is transforming the treatment landscape for prostate cancer. However, clinical data and outcomes for Asian patients remain limited and they are underrepresented in pivotal clinical trials. Although emerging retrospective series from Asia demonstrate comparable efficacy and safety profiles to Western cohorts, several points warrant attention. Asian men frequently present with aggressive, advanced-stage disease and distinct genomic profiles, characterized by lower rates of ERG fusions and TP53/PTEN mutations, and higher frequencies of FOXA1 and SPOP alterations. These genomic differences could influence PSMA expression and responsiveness to therapy. Additionally, Asian populations exhibit higher susceptibility to myelosuppression, necessitating careful patient selection and dose management. The development of region-specific radiopharmaceuticals and clinical trials, alongside systematic real-world data collection, will be essential for optimizing PSMA-targeted RLT in Asian contexts. Incorporating PSMA-based therapies earlier in disease management strategies also presents promising avenues for improving outcomes. Personalized approaches informed by ethnic-specific disease biology and clinical experience will be crucial for effectively bridging the current knowledge gaps in PSMA-targeted RLT for Asian prostate cancer patients.</p> Clinical trial number <p>Not applicable</p>