Prostate radioligand therapy (PRLT) with 177Lu-PSMA radiopharmaceutical therapy can be effective in advanced prostate cancer. It has got marketing approval as a third-line therapy, based on two trials published in high-ranked journals. I had personal experience of treating prostate cancer patients for several years—some cases are presented in the chapter, and even miracle response occurs. I also propose, based on own experience and literature reviews, that 177Lu-PSMA should be studied as a new potential treatment of incurable metastatic prostate cancer instead of chemotherapy, besides the chemotherapy and not only in castration/hormone resistant phase but also as first-line therapy. Some dosimetry and toxicity data is presented as well. Because this PRLT made nuclear medicine practice more clinical, a patient-reported outcome tool was developed for those patients coming from long distances, because 75% of patients with advanced disease responded and they had tumor lysis related symptoms.