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Doctors monitor side effects during radiopharmaceutical treatment with a plan tailored to the specific drug, cancer, dosing schedule, the patient’s health, and the treating center’s protocol. Depending on the treatment, that plan may include blood counts, kidney or liver tests, symptom checks, and separate measurements of how the cancer is responding. There is no single testing calendar for every radiopharmaceutical. Ask your nuclear-medicine and oncology teams which tests you need and when they are due.
What monitoring is meant to catch
A radiopharmaceutical combines a radioactive atom with a molecule that targets cancer cells. Different treatments target different diseases and can have different effects on the body, so the tests and follow-up used for one drug should not be assumed to apply to another. The Society of Nuclear Medicine and Molecular Imaging’s overview of radiopharmaceutical therapy and prostate cancer explains this treatment approach; the National Cancer Institute’s radiopharmaceutical therapy interest group lists approved treatments for multiple diseases, including Pluvicto, Lutathera, Xofigo, Azedra, and iodine-131.
Monitoring is meant to help the care team identify toxicity and decide whether treatment can proceed as planned. For the examples described here, this includes checking blood-cell counts and, for Pluvicto, kidney function. Clinicians also ask about symptoms. Separately, they may measure cancer markers to assess response. A change in a response marker is not itself a side-effect test.
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These are examples, not a shared protocol for all radiopharmaceuticals. The details below are US-centered: Pluvicto information comes from its 2026 US prescribing information, while the schedules for both treatments also draw on SNMMI patient guidance. Your care team’s instructions and the current information for your prescribed treatment should guide your own schedule.
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Which checks may be part of follow-up?
Blood counts
A complete blood count (CBC) measures red blood cells, white blood cells, and platelets. These components serve different purposes: red blood cells carry oxygen, white blood cells help the body fight infection, and platelets help blood clot. Treatment-related reductions may be described as anemia or decreased hemoglobin, low white-cell or neutrophil counts, or low platelets. A clinician can interpret your results in context; an abnormal result does not, by itself, establish what will happen to your next dose.
The FDA’s 2026 Pluvicto prescribing information directs clinicians to perform CBCs before and during treatment. Its guidance discusses withholding, reducing, or permanently discontinuing treatment according to the severity of myelosuppression. Those are possible clinician decisions based on toxicity severity, not automatic consequences of every out-of-range result.
Kidney and liver tests
For Pluvicto, the FDA label also directs kidney-function laboratory tests—including serum creatinine and calculated creatinine clearance—before and during treatment. It describes treatment changes based on the severity of renal toxicity. SNMMI’s patient guidance for Lu-177 PSMA therapy also lists kidney and liver function among tests obtained several days before each treatment. The guidance does not establish a single interval that should be used for every patient.
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These tests answer different questions from the CBC. Kidney-function tests assess how the kidneys are functioning; liver-function tests assess liver-related measures. The Pluvicto label specifically calls for kidney testing. Do not infer that a liver test or a particular schedule is required for another radiopharmaceutical just because it appears in patient guidance for Lu-177 PSMA therapy.
Symptoms and how you feel
Laboratory testing cannot describe every side effect, so follow-up also includes discussion of symptoms. SNMMI identifies fatigue and dry mouth as main side effects described for Lu-177 PSMA therapy, and notes that pain may occur as tumors respond. That context does not mean a new symptom is necessarily caused by treatment; tell your team about new or worsening symptoms so they can assess them in light of your treatment and health.
How monitoring differs between two prostate-cancer treatments
Pluvicto and radium-223 illustrate why schedules must stay attached to the named treatment. The patient guidance and prescribing information describe different details. Do not transfer the timing or tests for one drug to the other.
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| Treatment | Blood-count timing | Other tests and follow-up |
|---|---|---|
| Lu-177 PSMA therapy (Pluvicto) | The FDA’s 2026 label calls for CBCs before and during treatment. SNMMI says tests are obtained several days before each treatment and lists red cells, white cells, and platelets. | The FDA label calls for serum creatinine and calculated creatinine clearance before and during treatment. SNMMI also lists kidney and liver function and describes PSA follow-up. |
| Radium-223 (Xofigo) | SNMMI says blood counts are checked before treatment starts and no later than 10 days before every therapy cycle; further blood work may be obtained as needed. | SNMMI describes PSA and alkaline phosphatase as markers used to track prostate cancer and bone disease. |
For the radium-223 schedule and follow-up details, see SNMMI’s Radium-223 patient guidance. Its timing belongs to that treatment’s guidance; it is not a Pluvicto schedule. The Pluvicto label’s “before and during treatment” instruction also should not be turned into a universal number of days before an infusion: the label does not give that interval in the cited direction.
What the Pluvicto study figures do—and do not—tell you
The FDA label reports particular adverse events observed in named studies. These figures can help explain why clinicians monitor blood counts and kidney function, but they are not an individual prediction. They describe patients receiving Pluvicto in those trials, at the stated severity grade; they are not rates for all radiopharmaceuticals.
| Finding in the FDA label | Study and reported rate |
|---|---|
| Grade 3 or 4 decreased hemoglobin | 15% in VISION |
| Grade 3 or 4 decreased platelets | 9% in VISION |
| Grade 3 or 4 decreased leukocytes | 7% in VISION |
| Grade 3 or 4 decreased neutrophils | 4.5% in VISION |
| Grade 3 or higher pancytopenia | 1.1% in VISION, including two fatal events |
| Grade 3 or 4 acute kidney injury | 3.4% in VISION; 1.3% in PSMAfore; 1.6% in PSMAddition |
All figures are from the FDA’s 2026 Pluvicto label. The label cautions that adverse-event rates from different trials cannot be directly compared because trial conditions differ. In particular, the kidney-injury results across VISION, PSMAfore, and PSMAddition should not be read as a ranking of risk or as a prediction of what will happen to one person.
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Side-effect surveillance is not the same as checking whether treatment works
Safety checks and response measurements serve different purposes, even when both involve blood tests. A CBC or kidney-function test helps the care team evaluate treatment effects on the body. A tumor marker is used to follow the cancer. For example, SNMMI describes PSA follow-up during Lu-177 PSMA therapy; a decrease in PSA may indicate response, but it is not a test for side effects.
SNMMI also describes PSA and alkaline phosphatase as markers used in follow-up for prostate cancer and bone disease during radium-223 care. Your clinician can explain which markers are relevant to your case and how they fit with other assessments. A marker result should not be treated as a substitute for safety testing or symptom reporting.
What happens when a test or symptom raises concern?
Clinicians interpret results alongside their severity, trends, symptoms, and the treatment plan. For Pluvicto, the FDA label describes withholding, reducing, or permanently discontinuing treatment depending on the severity of myelosuppression or renal toxicity. This means a care team has options; it does not mean every abnormal test automatically stops therapy. The decision is specific to the patient and the treatment.
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Ask your team what a result means for your next scheduled dose and whether it changes the timing of a repeat test. If you notice a new or worsening symptom between visits, report it to your treatment team and ask whom to contact. The sources cited here do not establish a generic urgent-care rule for every symptom or treatment, so follow the contact instructions your team gives you.
Radiation-safety directions are a separate set of instructions
Instructions intended to limit other people’s exposure to radiation after a dose are not the same as checks for toxicity. They may apply even when you feel well, and they are specific to the treatment. Follow the written directions from your treatment center rather than assuming that another drug’s precautions apply.
For Pluvicto, the FDA’s 2026 US label gives these precautions after each administration:
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- Limit close contact—defined in the label as less than 3 feet—with others for 2 days, and with children and pregnant women for 7 days.
- Avoid sexual activity for 7 days.
- Sleep separately for 3 days from others, 7 days from children, or 15 days from pregnant women.
- Maintain hydration and urinate frequently before and after administration, as advised in the label.
These time periods are Pluvicto-specific US-label instructions, not a general rule for radiopharmaceutical treatment. SNMMI notes that the nuclear-medicine physician or radiologist will explain which precautions apply and for how long. If your written directions differ or are unclear, check with your own treatment center.
Questions to ask before the next dose
- Which blood counts and organ-function tests are planned for my treatment, and when are they due relative to each dose?
- Which symptoms should I report between appointments, and whom should I contact?
- How will you track whether the treatment is working, and which checks are for side effects instead?
- What radiation-safety instructions apply to my treatment and household after each dose?
Getting the schedule and contact instructions directly from the team matters because a monitoring plan is tied to the prescribed radiopharmaceutical and the individual treatment plan, not to a universal calendar.
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