Jeffrey Spier, MD; Brian Nabhan, MS, RT(T); Hector Santana, MAcc, MBA; Jameson Mendel, MD
Rio Grande Urology, El Paso, Texas
KEYWORDS:
Ambulatory care facilities; prostatic neoplasms, castration-resistant; continuity of patient care; molecular imaging; positron emission tomography computed tomography; precision medicine; prostatic neoplasms; radiopharmaceuticals; radioisotope teletherapy; urology
Abstract
Theranostics, the integration of molecular diagnostics with targeted radioligand therapy, is transforming the management of advanced prostate cancer. The clinical success of prostate-specific membrane antigen–targeted agents such as lutetium 177 PSMA-617 has established a new standard of care for patients with metastatic castration-resistant prostate cancer, creating an opportunity for urology practices to lead in this innovative field. This article provides a practical guide for independent urology groups to establish and operate an in-office theranostics center.
The field of oncology is undergoing a profound transformation, moving away from broadly cytotoxic agents toward highly specific, molecularly targeted therapies. Theranostics, a portmanteau of therapeutics and diagnostics, refers to the new evolution of personalized medicine—a “we see it, then we treat it” approach. This approach combines a diagnostic imaging agent with a therapeutic agent, targeting the same molecular marker on cancer cells and thereby improving patient selection, precision payload delivery, and toxicity profiles. Although the concept may seem novel, it dates back to the 1970s, when radioactive iodine (iodine 131) was used to treat thyroid cancer. In prostate cancer, the publication of the ALSYMPCA trial (ClinicalTrials.gov identifier NCT00699751) marked a turning point, ushering in a new era of radioligand therapy for patients with metastatic castration-resistant prostate cancer (mCRPC). Radium 223 dichloride (Xofigo [Bayer]) was the first a-particle–emitting radiopharmaceutical to demonstrate a survival benefit in this population.1
In advanced prostate cancer, prostate-specific membrane antigen (PSMA) has emerged as an ideal molecular target. It is a transmembrane protein, highly expressed on the surface of prostate cancer cells, with limited expression in most normal tissues. This biological characteristic has paved the way for the development of radioligand therapies, such as lutetium 177 PSMA-617, which are reshaping the standard of care in advanced prostate cancer.
The VISION trial (ClinicalTrials.gov identifier NCT03511664), a phase 3, international, open-label study, enrolled 831 men with PSMA-positive mCRPC that had already progressed after treatment with at least 1 novel androgen receptor pathway inhibitor (ARPI) and taxane chemotherapy. The addition of lutetium 177 PSMA-617 resulted in a 38% reduction in the risk of death, extending the median overall survival by 15.3 months vs 11.3 months (P < .001) while delaying the time to first symptomatic skeletal event and improving quality of life.2,3 More recently, the phase 3 PSMAfore trial (ClinicalTrials.gov identifier NCT04689828) investigated the role of lutetium 177 PSMA-617 in taxane-naive patients with mCRPC that had progressed on a prior ARPI. This study compared lutetium 177 PSMA-617 against a switch to a second ARPI (abiraterone or enzalutamide) and demonstrated a 59% reduction in the risk of radiographic progression or death, with the median radiographic progression-free survival of 12.0 months for patients receiving lutetium 177 PSMA-617 compared with just 5.6 months for patients switching ARPIs.4 The strength of the radiographic progressionfree survival data led to the expanded US Food and Drug Administration approval of Pluvicto (Novartis) in the prechemotherapy population on March 28, 2025.
Large urology group practices are ideally positioned, just as they have been with other novel ancillary services (eg, infusion services, men’s health, in-office pharmacy dispensing), to bring this treatment option to their patients in need of advanced prostate cancer care. Independent urology practices have consistently been able to forecast the need for state-of-the-art care for their patient population. Putting patients first while striving to implement cutting-edge approaches to patient care creates the proverbial “rising tide lifts all boats” scenario. Theranostics is a prime example.
Unlike large hospital systems, where theranostics may be housed in centralized radiology or oncology departments, urology practices have the flexibility to embed theranostics directly into the routine prostate cancer care pathway, creating a seamless experience for patients and enabling urologists to retain ownership of both diagnostic and therapeutic decisions. Clinically, the integration of PSMA-targeted positron emission tomography (PET) imaging and radioligand therapy directly within urology practices increases timely identification of metastatic or recurrent disease, enables rapid stratification of patients for systemic treatment, and preserves care continuity without the need for referrals outside the primary practice or health system.
Theranostics services should be designed as an extension of existing cancer care offerings, ideally situated adjacent to or within the same facility as standard prostate biopsy, imaging review, and systemic therapy consultations. This proximity reduces barriers to referrals, decreases time to treatment, and strengthens the urologist’s role as the central coordinator of care. Practices that already manage androgen-deprivation therapy, bone health agents, and chemotherapy referrals are particularly well positioned to assume responsibility for radioligand therapy evaluation and delivery. From a workflow standpoint, the integration of PSMA PET and lutetium 177 PSMA-617 therapy requires the designation of specific staff and physical zones for patient education, radiopharmaceutical handling, and posttherapy monitoring. Clinically, practices may designate a theranostics coordinator as the point person for scheduling scans and coordinating therapy logistics. This role helps ensure consistency, manage prior authorizations, and coordinate with nuclear medicine or radiation safety consultants.
Operational integration also depends on achieving the appropriate licensure and regulatory status. Practices must either work with an external authorized user or develop in-house capabilities under a state-granted radioactive materials (RAM) license. Coordination with state regulators or Agreement State authorities (eg, Texas Department of State Health Services for Texas practices) is essential early in the process. Importantly, integration does not necessarily require new construction; many practices can use or repurpose procedure rooms, examination rooms, or minor surgical areas for radiopharmaceutical administration with only modest modifications to shielding or airflow, depending on local rules and the half-life or activity of the agents used.
Overall, by embedding theranostics into existing operations, urology practices can maintain continuity of care, increase treatment uptake, and reduce attrition associated with external referrals. This integrated approach not only increases patient satisfaction and clinical efficiency but also generates new revenue potential in the context of prostate cancer management.
Positron emission tomography imaging with PSMA radiotracers has rapidly emerged as the standard of care in the staging and restaging of prostate cancer. The use of gallium 68 PSMA-11 and fluorine 18 DCFPyL has demonstrated superior sensitivity and specificity compared with conventional imaging modalities such as bone scan and computed tomography (CT), particularly in patients with biochemical recurrence and oligometastatic disease.5-7 Integration of PSMA PET into urology practices enables clinicians to more accurately assess disease burden, localize metastases, and guide therapeutic decisions without relying on external imaging services or delayed referrals, including candidacy for radioligand therapy. This ability creates a critical opportunity for urologists to reassert diagnostic leadership in advanced prostate cancer management.
The National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology for Prostate Cancer now recommend PSMA PET as the preferred imaging modality for men with unfavorable intermediate-risk, high-risk, very high-risk, and suspected metastatic or recurrent disease, replacing conventional imaging in most cases.8 Similarly, the American Urological Association and Society of Nuclear Medicine and Molecular Imaging have jointly endorsed PSMA PET for initial staging and for localization in the setting of rising prostate-specific antigen levels after definitive treatment.9 The implication is clear: To maintain alignment with clinical guidelines and optimize patient care, urology practices must incorporate PSMA PET imaging into their diagnostic toolkit.
Operationally, there are several pathways to offering PSMA PET. Practices may acquire a PET scanner on-site, partner with a mobile imaging professional, or refer patients to an external site. Each model has trade-offs related to capital expenditure, staffing, and scheduling control. On-site scanners allow for maximal workflow control and billing opportunities but require a substantial upfront investment, space reconfiguration, and shielding installation. In contrast, mobile PET services require less infrastructure but offer limited availability and scan throughput. Regardless of the delivery model, practices must coordinate with a cyclotron or generator supplier to ensure consistent access to gallium 68–labeled or fluorine 18–labeled tracers through either direct ordering or radiopharmacy partnerships.
Interpretation of PSMA PET requires credentialing in nuclear medicine or radiology, although collaborative models are emerging in which urologists co-manage image review with nuclear medicine physicians. To streamline workflows, urology practices can develop templated reporting systems and establish communication protocols to ensure timely interpretation and integration into clinical decision-making. In addition, practices should implement a standard operating procedure for patient preparation, tracer administration, and postscan monitoring, with attention to timing, hydration, and radiation safety protocols.
Radioligand therapy delivery in the office-based setting is a transformative opportunity for independent urology practices to expand into molecular therapy while maintaining direct control over the advanced treatment of prostate cancer. Since the Food and Drug Administration’s 2022 approval of Pluvicto (Novartis) for men with PSMA-positive mCRPC who have previously received ARPIs and taxane-based chemotherapy, there has been rapidly increasing interest in nonhospital settings offering this treatment.10
From a regulatory standpoint, the administration of radioligand therapy requires compliance with state and federal regulations governing RAM. Practices must obtain or amend their RAM licenses to include therapeutic uses of unsealed byproduct material under 10 US Code of Federal Regulations (CFR) Part 35.300, and an authorized user must be named on the license to supervise or personally administer the therapy.11 Notably, the systemic radiation exposure from lutetium 177 is low, and outpatient administration is feasible with appropriate patient education and facility precautions.12 By controlling the full episode of care, independent practices can increase revenue while ensuring rapid treatment delivery, a particularly important factor for patients with declining performance status or symptomatic progression.
Maintaining care continuity is essential to realizing the full clinical and operational benefits of a theranostics program within an independent urology practice. Historically, patients with advanced prostate cancer have been referred to external imaging centers, academic hospitals, or oncology networks for PSMA PET imaging or radioligand therapy. These handoffs often introduce delays, fragment the therapeutic decision-making process, and risk patient attrition at critical points in the disease trajectory. By integrating both diagnostic and therapeutic components of theranostics into the urology clinic, practices can provide a more cohesive, timely, and personalized care experience while reinforcing their central role in long-term cancer management.
Urologists already oversee the core elements of the prostate cancer journey, including initial diagnosis, treatment, and monitoring response to therapy. Incorporating theranostics allows expansion of this stewardship through later disease stages. Prostatespecific membrane antigen PET imaging facilitates early identification of metastatic lesions and can inform decisions about metastasis-directed therapy, systemic intensification, or entry into radioligand treatment protocols.13,14 By coordinating imaging within the same clinic and interpreting results alongside clinical data, urologists can ensure timely discussions with patients and accelerate initiation of the next line of therapy.
Care continuity is particularly critical for patients eligible for lutetium 177 PSMA therapy, many of whom have advanced disease, comorbidities, and limited performance reserves. Establishing standardized patient pathways, including initial eligibility screening, PSMA PET result review, shared decision-making, therapy scheduling, and posttreatment follow-up, helps ensure that patients are not lost between services. Dedicated theranostics coordinators or nurse navigators can facilitate this process by serving as the central contact for patients; managing documentation and insurance authorizations; and coordinating with nuclear medicine, pharmacy, and support services.
Close posttherapy follow-up further reinforces continuity and enables urologists to monitor therapeutic response, manage side effects, and plan the timing of additional treatment cycles. In the VISION trial, patients received a median of 5 or 6 cycles of lutetium 177 PSMA-617, highlighting the importance of longitudinal care planning and multidisciplinary collaboration.2 Theranostics also offers a platform for deeper engagement with patients and their families. Patients undergoing molecular imaging or radioligand therapy often have numerous questions about the technology, risks, benefits, and logistics. Providing these services within a familiar clinic environment allows for repeated touchpoints with the same care team, improving patient satisfaction and increasing adherence to treatment plans. Furthermore, integrated programs allow urology practices to track outcomes over time and contribute to registries or real-world evidence initiatives, reinforcing quality assurance and continuous improvement efforts.
A practical challenge for independent urology practices establishing theranostics centers lies in infrastructure planning. Although theranostics requires specific physical, technical, and radiation safety capabilities, it does not necessarily demand ground-up construction. With strategic modifications and compliance planning, many urology clinics can incorporate both PET imaging and radioligand therapy into their existing footprints, as shown in Figure 1, a repurposing of approximately 1900 ft2 formerly used as a pediatric urology clinic space. This approach reduces capital investment, shortens time to operational readiness, and maximizes the return on underused clinical space.
For PET imaging, particularly PSMA-targeted PET/CT, the primary infrastructure considerations include installation of a shielded scanner room, radiopharmaceutical handling area, dedicated restrooms, and patient preparation space. The scanner room must comply with federal and state radiation shielding requirements, typically designed in consultation with a medical physicist using occupancy and workload modeling to calculate barrier thickness and layout.15 Shielding materials may include lead, concrete, or proprietary modular systems. Patient preparation rooms adjacent to the scanner allow for efficient flow and accommodate the necessary waiting periods for radiotracer uptake.
Each space within the suite must be designed with its specific function and safety requirements in mind:
Hot lab. This restricted-access area is for radiation personnel only and must be equipped with a dose calibrator or well counter, L-block shield (or similar), area for hot storage, and lockable door. Key design features include nonporous, easily decontaminable surfaces (eg, seamless vinyl flooring, epoxy paint).
Therapy rooms (infusion and uptake rooms). These rooms should balance patient comfort with radiation safety. Shielding calculations, performed by a qualified medical physicist, include the weekly workload (number of patients), occupancy factor of adjacent areas, distance, and regulatory dose limits.
Dedicated patient restrooms. This is arguably one of the most critical design elements of a theranostics center. If not within the therapy room itself, the dedicated restroom must be immediately adjacent to the therapy room, minimizing patient travel through common spaces. The restroom itself should be finished with seamless, nonporous materials, including a low-pressure toilet to minimize contamination.
Imaging suite. A PET/CT scanner is indispensable for the diagnostic component of theranostics and necessary for identifying patient eligibility for therapy.
Radioactive waste storage. A secure, shielded, and properly labeled room or large closet is required for the decay-in-storage of all radioactive waste, including used vials, infusion tubing, and contaminated personal protective equipment.
(For a guided virtual tour of the Rio Grande Urology Theranostics and Molecular Imaging Center, scan the QR code in Figure 2.) The infrastructure for radioligand therapy delivery is similar. A dedicated therapy room must be designated for administration of lutetium 177 PSMA-617, and this space must meet regulatory criteria for shielding, contamination control, and radiation safety. In most outpatient settings, this includes sealed flooring and proximity to a private restroom for patient use during the postadministration period.16 The therapy room should include radiation signage, closed-circuit monitoring if physical isolation is needed, and secure pathways for radioactive waste collection. A nearby hot lab, used for receiving and preparing doses of radiopharmaceuticals, must also meet shielding and security requirements. Hot lab design can vary based on expected throughput but typically includes lead-lined storage cabinets, dose calibrators, L-blocks, and contamination monitoring equipment.17
Space utilization planning must consider radiation zoning, staff workflow, and patient privacy. For practices that repurpose existing rooms, conversion of underused procedure or storage rooms is often feasible. Modular wall panels and shielded mobile barriers can offer flexible retrofitting solutions with faster deployment than permanent construction. In higher-volume practices, separate entry and exit paths and posttherapy discharge areas may improve patient flow and minimize occupational exposure for staff.
Successful establishment of a theranostics center requires a methodical approach to obtain or amend 2 main regulatory items: the RAM license and Centers for Medicare & Medicaid Services facility accreditation. Radioligand therapies are strictly regulated to ensure the safety of patients, staff, and the public. Depending on the state, regulatory authority rests with either the US Nuclear Regulatory Commission or an Agreement State agency.
Agreement States have entered into formal agreements with the Nuclear Regulatory Commission to assume regulatory authority over the use of these materials within their borders (see Figure 3).18 The application process varies from state to state but is outlined in the NUREG-1556, Volume 9, Revision 3, “Consolidated Guidance About Materials Licenses: Program-Specific Guidance About Medical Use Licenses.”19 For practices that already hold a RAM license, the existing license must be amended for each new diagnostic agent or therapy and must be approved by the regulatory authority before any new activities can begin. In addition, the Medicare Improvements for Patients and Providers Act of 2008 mandates that all facilities billing Medicare for the technical component of advanced diagnostic imaging services (ie, PET scans) be accredited by a Centers for Medicare & Medicaid Services–designated organization to receive reimbursement.20
Figure 1. Finalized theranostics suite layout for Rio Grande Urology Abbreviation: PET/CT, positron emission tomography/computed tomography.
Figure 2. QR code for Rio Grande Urology theranostics suite design video
Once licensed and accredited, the center must adhere to a strict set of operational regulations outlined in 10 CFR Part 35:
Written directives (10 CFR Part 35.41). A written directive, which is a formal order signed by an authorized user, is required before any therapeutic radiopharmaceutical is administered. This directive must contain the patient’s name, the radiopharmaceutical, and the prescribed dosage.21
Patient release criteria (10 CFR Part 35.75). A patient administered a radiopharmaceutical can be released from the facility if the total effective dose equivalent to any other person (eg, a family member) is not likely to exceed 5 mSv (500 mrem).22
Patient instructions. If the dose to another person is likely to exceed 1 mSv (100 mrem), the licensee must provide the released patient with written instructions on how to keep doses to others as low as reasonably achievable. These instructions typically include guidance on maintaining distance from others, sleeping separately, and following hygiene practices for a specified period.22
Waste management. Radioactive waste must be appropriately disposed of as low-level radioactive waste.
The design of a theranostics center is dictated by the fundamental principles of radiation safety, patient-centered care, and operational efficiency. A well-designed facility not only ensures regulatory compliance but enhances the patient experience and optimizes staff workflow, which is critical for a high-volume, high-cost service line. Developing the theranostics team is a crucial component for operations, patient safety, and patient satisfaction. Table 1 lists the main members of this team and their roles.
Upon arrival, the clinic’s staff must follow strict procedures for receiving a radioactive package. These procedures include performing a radiation survey of the exterior of the package to check for leaks or contamination, verifying that the contents and activity match the shipping manifest, and securely logging the material into the site’s RAM inventory. The dose must be stored in a locked, shielded container in the hot lab until it is time for administration.23 Immediately before treatment, qualified personnel must independently assay the dose in the clinic’s calibrated dose calibrator to verify that its activity matches the prescription on the authorized user’s written directive. This final check is a critical safety step to prevent a medical event.
Billing and coding for PSMA-targeted PET/CT imaging requires careful alignment with established procedural and diagnostic code sets to ensure reimbursement and compliance with payer policies. The most commonly used procedural code for PSMA PET/CT is Current Procedural Terminology code 78816, which describes a whole-body PET scan performed with concurrently acquired diagnostic CT for attenuation correction and anatomical localization.24 This code is appropriate when PSMA imaging is performed for prostate cancer staging or restaging with agents such as gallium 68 gozetotide or fluorine 18 piflufolastat. The radiopharmaceuticals themselves are billed separately with Healthcare Common Procedure Coding System Level II codes, including A9800 for gallium 68 gozetotide and A9595 for fluorine 18 piflufolastat, which are billed as single-unit per-dose codes, regardless of activity level.25
Agreement States are states that have entered into agreements with the Nuclear Regulatory Commission, allowing them to regulate the use of certain radioactive materials within their borders
Medical necessity must be clearly documented with International Statistical Classification of Diseases, Tenth Revision diagnosis codes reflecting the clinical indication. The most relevant codes include C61 for malignant neoplasm of the prostate, Z85.46 for a history of prostate cancer, and R97.21 for elevated prostate-specific antigen levels. These diagnosis codes support indications consistent with National Comprehensive Cancer Network guidelines, including initial staging of high-risk prostate cancer, localization of recurrence after definitive therapy, and assessment for metastatic castration-resistant disease.26 Medicare provides national coverage for PSMA PET imaging under National Coverage Determination 220.6.20 when performed for these oncologic indications, although commercial payer policies may vary and often require preauthorization based on specific clinical criteria.
Billing practices must also consider the technical and professional components of the scan. Modifiers -TC and -26 are applied when billing separately for technical and professional services, respectively, and global billing applies when both components are provided by the same entity. The place of service code should accurately reflect the setting in which the scan is performed. As reimbursement for molecular imaging evolves, accurate coding and documentation remain essential to ensuring financial sustainability and regulatory compliance for practices implementing PSMA PET/CT services.24,27
The rapid incorporation of theranostics models into urology practices has brought adoption challenges to managers and clinical staff. These challenges vary across diverse adopters, including management, staff, payers, suppliers, and government agencies. To facilitate adoption by all stakeholders, Everett Rogers’s diffusion of innovations theory can be used as a guiding framework. Under this approach, stakeholders can be classified as early adopters, late adopters, early majority, late majority, and laggards. To bring value to this initiative, the framework can be applied as follows:
Management. Management must take an early adoption perspective to prevent conflict or disruption. Having clear direction on department needs and expectations from an operational and financial standpoint makes a big difference. Management must communicate efficiently about policies and procedures, referral processes, payment plans, payer coverage, supply management, and revenue cycle management.
Staff. Like management, staff must take an early adoption perspective. Because most referrals will come from urologists, educating the staff about this specialty is extremely important to create awareness and understanding of the benefits that this initiative brings to the enterprise.
Payers. Although payers are typically late majority adopters and sometime laggards, they must be consulted about the necessary billing codes and required documentation. Because of the inconsistency of information on payer portals, an audit trail must be incorporated into the practice to ensure correct processing of claims and payments.
Suppliers. Because suppliers are the innovators in this process, they possess most of the bargaining power in all negotiations. Urology groups must be wary about purchase agreement verbiage and should explore all available supply options to build leverage.
Government agencies. Government agencies can be considered early adopters, and as such they are a valuable source of guidance in obtaining the required certification to provide patient treatment services. Doing so will prevent any disruption in revenue cycle management.
The journey to establishing a private theranostics center is complex and capital intensive, requiring a unique fusion of clinical expertise, business acumen, and regulatory diligence. By building the necessary infrastructure and expertise now, private practices can not only meet the current, pressing needs of their patients but also create a scalable platform for growth, innovation, and leadership in the era of personalized cancer treatment. The future of theranostics is bright, with a rich pipeline of new agents that will soon move current therapies into earlier lines of treatment (eg, PSMAddition trial [ClinicalTrials.gov identifier NCT04720157]) and a broader range of cancer types.28,29 Carbonic anhydrase IX has emerged as a highly specific theranostic target for clear cell renal cell carcinoma because it is overexpressed in more than 95% of cases.29 The pivotal phase 3 ZIRCON trial (ClinicalTrials.gov identifier NCT03849118) validated this target, demonstrating that PET/CT imaging with the antibody-based agent zirconium 89 girentuximab can noninvasively identify clear cell renal cell carcinoma in patients with high sensitivity (86%) and specificity (87%).24 Urology practices can capitalize on this new technology by providing novel diagnostics and therapeutics to their patients.
It has been enormously rewarding to offer advanced imaging with PET PSMA and radioligand therapy to our community. The ability to maintain the patient-physician relationship throughout the patient cancer care continuum is paramount. Trust has been built, and it is remarkably rewarding to treat these men from diagnosis through the journey of prostate cancer progression. Urologists around the country are poised to be leaders in the field of radioligand therapy by building strong multidisciplinary teams. The challenges may seem daunting, but for those with the vision and determination to meet them, the reward is the ability to offer new hope and a better quality of life to patients who previously had very limited treatment options.
Parker C, Nilsson S, Heinrich D, et al. Alpha emitter radium-223 and survival in metastatic prostate cancer. N Engl J Med. 2013;369(3):213-223. doi:10.1056/NEJMoa1213755
Sartor O, de Bono J, Chi KN, et al. Lutetium-177–PSMA-617 for metastatic castration-resistant prostate cancer. N Engl J Med. 2021;385(12):1091-1103. doi:10.1056/NEJ-Moa2107322
Fizazi K, Herrmann K, Krause BJ, et al. Health-related quality of life and pain outcomes with [177Lu]Lu-PSMA-617 plus standard of care versus standard of care in patients with metastatic castration-resistant prostate cancer (VISION): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2023;24(7):751-762. doi:10.1016/S1470-2045(23)00158-4
Morris MJ, Castellano D, Herrmann K, et al. 177Lu-PS-MA-617 versus a change of androgen receptor pathway inhibitor therapy for taxane-naive patients with progressive metastatic castration-resistant prostate cancer (PSMAfore): a phase 3, randomised, controlled trial. Lancet. 2024;404(10459):1227-1239. doi:10.1016/S0140-6736(24)01653-2
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Published: October 5, 2025.
Conflict of Interest Disclosures: None of the authors have any conflicts of interest to disclose.
Funding/Support: Publication of this article was made possible through the generous support of Novartis. Content of this article was solely that of the authors.
Author Contributions: All authors were involved in study conception and design, data analysis and interpretation, drafting the manuscript, and critically revising the manuscript for intellectual content. All authors approved the final version of the manuscript to be published and agree to be accountable for all aspects of the work.
Data Availability Statement: All data sources are cited and publicly available.
Citation: Spier J, Nabhan B, Santana H, Mendel J. Building and operating a urologic theranostics center: a practical guide. Rev Urol. 2025;24(3):e95-e106.
Corresponding author: Jeffrey Spier, MD, 7420 Remcon Circle, Building C, El Paso, TX 79912 (jspier@riograndeurology.com)
