Gallium-68
A radioactive metal with a one-hour lifetime that is eluted from a shielded generator or made on a cyclotron and attached to a molecule that finds tumours, giving a PET scan the same day.
Overview
Gallium-68 decays with a 67.7-minute half-life, mostly by positron emission, and is the diagnostic half of two of the most important theranostic pairs in oncology: 68Ga-DOTATATE/DOTATOC paired with 177Lu-DOTATATE for neuroendocrine tumours, and 68Ga-PSMA-11 paired with 177Lu-PSMA-617 or 225Ac-PSMA for prostate cancer.
It is traditionally produced by eluting a 68Ge/68Ga generator, where the 270.8-day parent 68Ge is fixed to a column and decays continuously; the daughter is washed off with dilute acid on demand. Commercial GMP generators (Eckert & Ziegler, IRE, ITG) top out at 1.85-3.7 GBq per elution, and lead times for new units have historically run to 18 months, which constrained the launch of PSMA PET in the late 2010s. A cyclotron route, direct 68Zn(p,n)68Ga irradiation of a liquid or solid target, produces roughly a curie per run against a generator's 40-50 mCi and has been promoted by the IAEA since a 2019 technical document and a 2020 coordinated research project as the way to relieve that bottleneck.
By the mid-2020s the practical supply picture had eased: Eckert & Ziegler expanded generator manufacturing capacity after a 2017 germanium shortage, and cyclotron-produced 68Ga (including for PSMA-11) is now used at large centres alongside the F-18-labelled PSMA alternatives (Pylarify, PSMA-1007, flotufolastat) that took share once generator lead times became a launch constraint.
- β+ 89% (max 1.90 MeV)
- electron capture 11%
- annihilation γ 511 keV
- DOTA
- NOTA
- HBED-CC
Theranostic partners
- Lutetium-177 · A radioactive metal that gives off short-range radiation. Attached to a molecule that sticks to a tumour, it irradiates the tumour from the inside while sparing most healthy tissue.
- Actinium-225 · A metal that fires off very powerful, very short-range radioactive particles as it decays through a chain of daughter atoms. Because the particles barely travel beyond the cell they hit, it can kill a cancer cell while leaving neighbouring healthy cells mostly untouched. Supply is scarce, so it is still mostly used in research studies.
Choline C-11 was the first PET tracer approved in the United States, in 2012, to find where prostate cancer has come back when PSA rises after treatment; PSMA tracers have now largely replaced it.
An injectable tracer that sticks to a marker (somatostatin receptor) many neuroendocrine tumours carry. A PET scan afterwards shows where those tumours are, including small deposits that other scans can miss.
An experimental PET tracer for prostate cancer that binds the same target as approved PSMA scans (PSMA) but, because its radioactive tag lasts longer, can be re-imaged a day later to catch small deposits the first picture missed. It is not yet approved for sale.
A FAP-targeted theranostic pair: one version images almost any solid tumour, the other treats it with radiation.
Florastamin is FutureChem's fluorine-18 PSMA PET tracer, and the first prostate cancer diagnostic developed in South Korea to be approved there — Korea's 43rd domestically developed new drug.
Flotufolastat is a third PSMA PET tracer, with a radiohybrid chemistry designed to be reused for therapy.
Fluciclovine F-18 was the first PET tracer approved for finding recurrent prostate cancer after treatment (2016), and has been largely superseded since 2020 by PSMA PET.
A tracer originally built to look at brain dopamine cells in suspected Parkinson's disease. Because certain hormone-producing tumours use the same chemical machinery, doctors also use it, off-label, to find those tumours -- especially adrenal gland tumours called pheochromocytoma.
The PET scan for neuroendocrine tumours that finds far more disease than older scans and confirms eligibility for lutetium radioligand therapy (the theranostic pair).
A cousin of the Ga-68 DOTATATE and Cu-64 DOTATATE scans: it sticks to the same receptor on neuroendocrine tumours and lets PET find them. It is FDA-approved but, unusually, has no brand name and no pharmaceutical-company sponsor.
An experimental PET tracer that lights up the scaffolding cells cancers build around themselves, not the cancer cells directly. It is still being tested, not yet an approved medicine.
Gallium-68 PSMA-11 was the first PSMA PET tracer approved in the US (2020), and is made on site from a generator or cyclotron.
An experimental PET tracer that looks for a specific docking protein (CXCR4) that some blood cancers and a minority of solid tumours carry in excess. It is a research tool, not an approved scan.
Telix's ready-to-label kit that lets any nuclear medicine department make the gallium PSMA scan for prostate cancer.
The original nuclear medicine scan for finding neuroendocrine tumours, used before PET scans like Ga-68 DOTATATE became available. It is still FDA-approved but has largely been superseded because PET gives sharper pictures with less radiation.
An injectable tracer that mimics a stress hormone and gets taken up by certain nerve-related tumours, such as pheochromocytoma and childhood neuroblastoma, so a scan afterwards can show where they are.
Novartis' gallium PSMA scan kit, approved the same day as Pluvicto as the test that qualifies men for that radioactive drug.
Piflufolastat F-18 (Pylarify) is the leading PSMA PET tracer for prostate cancer, with a new formulation approved in March 2026.
PSMA-1007 is a fluorine-18 PSMA PET tracer from ABX in Germany, widely used in Europe for prostate cancer staging because little of it reaches the bladder, and in a phase 3 trial registered by its maker.
A version of the PSMA prostate cancer scan that uses the same cheap, widely available radioactive tag as a standard bone scan instead of the PET tracers. Surgeons can also carry a small radiation detector into the operating room to help find and remove cancerous lymph nodes. It has not been through formal drug approval; it is used as an academic, in-house preparation.
This guideline tells doctors and insurers exactly which clinical situations justify a PSMA PET scan for prostate cancer - mainly staging higher-risk disease, investigating a PSA rise after treatment, and checking that a patient's cancer will respond to PSMA radioligand therapy - and which situations do not.
For men whose prostate cancer has grown after chemotherapy, a PSMA-targeted radioactive treatment worked at least as well as, and was gentler than, the chemotherapy drug it replaced - provided a PET scan first confirms the cancer takes up the PSMA tracer.
PSMA PET-CT is the preferred staging investigation for high-risk prostate cancer and for biochemical recurrence, though most treatment trials were designed with conventional imaging.
In a small early trial, most heavily pre-treated men with advanced prostate cancer responded to the PSMA-targeted radioactive drug, with manageable side effects, supporting the case for testing it in larger randomised trials.
In the largest reported group of neuroendocrine tumour patients treated with individually dosed radioactive peptide therapy, most people lived several years after treatment, and serious long-term harms such as blood cancers were uncommon but real, occurring in about 1 in 50 patients.
This was the first evidence, in two patients, that attaching a more powerful (alpha-emitting) form of radiation to the same PSMA-seeking molecule used in lutetium-177 PSMA therapy could produce a complete response even in prostate cancer that had already stopped responding to the beta-emitter version.
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