# Site readiness and referral pathway delays

Source: https://nuclide.cc/bottlenecks/b-site-readiness-referral/  
Nuclide record `b-site-readiness-referral` (Bottleneck). Data CC BY-NC 4.0, attribute "Data from Nuclide (nuclide.cc)"; commercial use needs a licence.

## TL;DR

Getting a patient from 'this treatment might help you' to actually receiving it can take weeks or months, because the scan, the specialist review and the treatment often happen at different places, and not every hospital is equipped to give the treatment at all.

## Summary

Radioligand therapy referral is a multi-step journey: a treating physician suspects eligibility, the patient needs a PSMA- or somatostatin-receptor PET scan (often at a different centre from where the eligibility decision or treatment happens), a multidisciplinary team reviews the scan, and only then is the patient scheduled at a licensed, hot-lab-equipped centre. A 2025 IQVIA Institute study of the mCRPC referral pathway in Germany, France, Italy and China found this took a minimum of about 7 weeks in Germany, 8-9 weeks in France and China, and roughly 11 weeks in Italy, with limited PSMA PET-CT capacity and unclear division of responsibility between urologists, oncologists and nuclear medicine physicians cited as common barriers across all four countries.

A report from Dana-Farber Cancer Institute tracking 146 patients referred for 177Lu-PSMA-617 between May and October 2022 found the median time from tumour-board review to first treatment cycle rose from 41 days in May to 96 days in October as supply tightened; 35% of patients (45 of 146) started or continued a different therapy rather than wait, and 5% of approved patients (6 of 127) died during the wait. A 2022 international SNMMI survey of prostate cancer theranostics sites found a mean PSMA PET waiting time of 17±16 days (median 10, range 1-120), with the longest waits reported in Africa, and one-third of responding centres saying they lacked sufficient PET imaging capacity to meet demand.

Imaging-capacity concentration compounds the problem: a UK health-system-readiness review found only ten centres nationally offer gallium-68 DOTATATE/TOC PET-CT for neuroendocrine tumours, nine of them in or around London, forcing many patients to travel long distances simply to be assessed for eligibility before any decision about treatment itself.

## Fields

- Kind: Bottleneck
- Last checked: 2026-09-22
- Tags: access; referral; care pathway
- Stage: access-delivery
- Severity: major
- Metrics: Minimum referral-to-treatment-initiation time for mCRPC radioligand therapy (Germany, France, Italy, China): 7–11 weeks, depending on country; Dana-Farber: median tumour-board-to-cycle-1 wait, May vs October 2022: 41 days → 96 days; Dana-Farber cohort: patients who switched to a different therapy while waiting: 35% (45 of 146); Dana-Farber cohort: approved patients who died before starting treatment: 5% (6 of 127); Mean PSMA PET wait time, international 2022 survey: 17±16 days (median 10, range 1–120); UK centres offering Ga-68 DOTATATE/TOC PET-CT for neuroendocrine tumours: 10 nationally, 9 in/around London
- Causes: The referral pathway crosses multiple specialties (urology/oncology, nuclear medicine, radiology) with no universally standardised handoff or shared ownership.; PSMA- and SSTR-PET imaging capacity, which is required to confirm eligibility, is concentrated at a small number of centres, often geographically distant from the referring clinic.; Community oncology and urology clinics frequently lack the NRC/Agreement-State licensure and hot-lab infrastructure to administer the therapy themselves, so patients must be referred out.; Disease can progress or the patient's clinical status can change during the referral-to-treatment interval, sometimes invalidating the original eligibility scan.

## Sources

- IQVIA Institute: Developing efficient patient referral pathways for radioligand therapies (2025): https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/developing-efficient-patient-referral-pathways-for-radioligand-therapies
- Targeted Oncology: Oncologists encounter challenges accessing PSMA-targeted therapy (Dana-Farber data): https://www.targetedonc.com/view/oncologists-encounter-challenges-to-accessing-psma-targeted-therapy-in-prostate-cancer
- A 2022 international survey on the status of prostate cancer theranostics (JNM): https://jnm.snmjournals.org/content/64/1/47
- Health system readiness for radioligand therapy in the UK: service provision: https://www.healthsystemreadiness.com/app/uploads/Health-system-readiness-for-radioligand-therapy-in-the-UK-Service-provision.pdf

## Connected records

- bottlenecks: [Authorized user shortage for radionuclide therapy](https://nuclide.cc/bottlenecks/b-authorized-user-shortage/), [Clinical trial capacity for radioligand therapy](https://nuclide.cc/bottlenecks/b-rlt-trial-capacity/), [Cold chain and time-critical logistics](https://nuclide.cc/bottlenecks/b-cold-chain-logistics/), [Hot lab and shielded treatment room capacity](https://nuclide.cc/bottlenecks/b-hot-lab-capacity/), [Radioactive waste handling and disposal regulation](https://nuclide.cc/bottlenecks/b-radioactive-waste-regulation/), [Reimbursement and coding for radiopharmaceuticals](https://nuclide.cc/bottlenecks/b-reimbursement-coding/)
- isotopes: [Gallium-68](https://nuclide.cc/isotopes/ga-68/), [Lutetium-177](https://nuclide.cc/isotopes/lu-177/)
- indications: [Metastatic castration-resistant prostate cancer](https://nuclide.cc/indications/prostate-mcrpc/), [Neuroendocrine tumours](https://nuclide.cc/indications/neuroendocrine/)
- technologies: [PSMA PET](https://nuclide.cc/technologies/psma-pet/), [Radiopharmacy and cyclotron networks](https://nuclide.cc/technologies/radiopharmacy-network/), [Somatostatin receptor PET (68Ga/64Cu-DOTATATE)](https://nuclide.cc/technologies/sstr-pet/)
- drugs: [Gallium-68 DOTATATE (and Cu-64 DOTATATE)](https://nuclide.cc/drugs/ga68-dotatate/), [Gallium-68 gozetotide (PSMA-11)](https://nuclide.cc/drugs/ga68-psma-11/), [Lutetium-177 vipivotide tetraxetan](https://nuclide.cc/drugs/pluvicto/)
- institutions: [Dana-Farber Brigham Cancer Center](https://nuclide.cc/institutions/dana-farber/), [Society of Nuclear Medicine and Molecular Imaging](https://nuclide.cc/institutions/snmmi/)

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