This session offers a comprehensive and candid review of the evolution, current impact, and future direction of radiotheranostics, with a particular focus on PSMA targeted imaging and therapy in prostate cancer. Tracing the field from its roots in basic and translational science to contemporary phase III trials and real world adoption, the presentation examines diagnostic and therapeutic successes alongside persistent challenges, including variable response rates, resistance mechanisms, toxicity, and uncertain survival benefits in earlier disease settings. Beyond clinical outcomes, the session explores the expanding role of industry, regulatory milestones, workforce and infrastructure constraints, and the “turf” issues that accompany rapid growth. Participants will gain insight into emerging targets, rational combination strategies, patient selection, and the critical need for multidisciplinary collaboration to ensure that radiotheranostics remains patient centered, scientifically rigorous, and sustainable as the field continues to scale.