Theranostics has moved from niche to mainstream. Lu-177 PSMA for metastatic prostate cancer, Lu-177 DOTATATE for neuroendocrine tumours, and an expanding pipeline of targeted therapies are now part of everyday cancer care in many Australian centres. The growth is real — and the workforce isn’t ready.
What theranostics actually is
Theranostics combines diagnosis and treatment in a single molecular approach. A PET scan identifies a specific receptor on a cancer cell — PSMA on prostate cancer, for instance. The same targeting molecule is then paired with a radioactive therapeutic isotope, most commonly Lutetium-177 (Lu-177) and, increasingly, Actinium-225, and delivered to destroy that exact target.
It is precision oncology in practice. Unlike external-beam radiation or traditional systemic therapy, the treatment travels through the bloodstream and binds only to cells expressing the targeted marker.
For clinicians, that means a new category of service. Imaging teams plan the therapy. Radiation oncologists prescribe it. Nuclear medicine physicians deliver it. Radiopharmacy scientists prepare it. The individual roles aren’t new — but the combination is.
Why Australia is scaling faster than the workforce
The clinical case for theranostics is strong. Landmark trials such as VISION and TheraP showed meaningful overall survival benefits for Lu-177 PSMA in metastatic castration-resistant prostate cancer. Lu-177 DOTATATE has become standard of care for many neuroendocrine tumours. Reimbursement through the PBS (the Pharmaceutical Benefits Scheme) and state-funded programmes has widened access.
The workforce side of the equation hasn’t kept pace.
Australia has one of the lower densities of nuclear medicine physicians in the OECD. Radiopharmacy scientists are in short supply. Nurses and technologists trained in radioactive therapy delivery are concentrated in a handful of major centres. Regional and rural patients still travel — sometimes interstate — for treatment.
The gap becomes visible every time a new service opens. Capital funds the suite. The therapy is approved. Patients are referred. Then the waiting list forms — not because the drug isn’t available, but because the team isn’t there to deliver it.
Where the opportunity sits for radiologists and radiation oncologists
For clinicians weighing a career move, theranostics is one of the few corners of imaging and oncology where demand is clearly outstripping supply.
Nuclear medicine physicians are in the strongest position. Those already practising can expand scope into therapy delivery. Those considering a move from diagnostic radiology or radiation oncology will find that fellowship pathways and sub-specialty training are becoming more accessible, with RANZCR (the Royal Australian and New Zealand College of Radiologists) and the Royal Australasian College of Physicians both playing a role in credentialing.
Radiation oncologists are increasingly embedded in multidisciplinary theranostics teams, particularly where external-beam and systemic-isotope therapy combine. Diagnostic radiologists with PET or hybrid-imaging experience are well placed to move into theranostics planning and response assessment.
The common thread is crossover. Theranostics doesn’t replace existing specialties — it draws from all of them.
What employers and service leads should be asking now
For cancer centres, private imaging groups and public health services planning or expanding a theranostics service, the right questions are less about equipment and more about people.
How many theranostics sessions can the current nuclear medicine workforce actually support — and what is the plan for the next twelve months? Is there a reliable radiopharmacy partner for Lu-177 supply, and a forward view on Actinium-225? Are nursing and technologist staff trained in radioactive therapy administration and the regulatory obligations that come with it? And how will the service handle the downstream work — imaging follow-up, dosimetry, multidisciplinary review?
Services that answer the workforce question ahead of launch tend to ramp faster and avoid the waiting-list trap. Those that don’t often find the clinical case is easier than the operational one. Looking ahead, three shifts are worth tracking through the rest of 2026: how quickly fellowship and training capacity expands, how Actinium-225 supply develops, and where federal and state reimbursement lands. Each will shape whether the access gap widens or narrows.
Theranostics isn’t the next frontier. It’s the current one. The services that build the team around it — not just the suite — will lead. If you’re a nuclear medicine physician, radiation oncologist or diagnostic radiologist weighing a move into theranostics, or an employer planning a new service, the GCG team is happy to help you think through the workforce and career side. Get in touch, or read more resources on our blog.
