在过去的十年里，监管机构已经批准了两种新的放射性核素治疗方式，223Ra-二氯化物和以前列腺特异性膜抗原（PSMA）为靶点的放射性配体治疗（RLT），用于治疗去势耐药性前列腺癌（PCa）。本文重点介绍了PCa分子影像学的基本原理，并着重介绍了一种独特的方法——联合诊断与治疗（所谓的治疗学），旨在针对接受223Ra-二氯化物或PSMA靶向治疗的患者进行响应预测和评估。在这个视角下，本文介绍了放射诊断学这一新兴学科从医学图像中提取定量特征的潜力。: 治疗代谢和分子探针已成功应用于预测和监测放射性核素基础治疗的反应。特别是，99mTc-MDP和18F-NaF在223Ra疗法之前是个有用的个性化剂量测定和预后分层工具，而PSMA配基单独或与18F-FDG结合使用，为选择更容易从RLT获益和了解PCa分化和攻击性更高的患者提供了有价值的信息。尽管具有很高的潜力，但针对PCa的PET放射治疗仍处于萌芽阶段，需要进一步验证。

: In the last decade two new radionuclide-based therapies, 223Ra-dichloride and radioligand therapy (RLT) targeting prostate specific membrane antigen (PSMA), have been approved by the regulatory authorities for the management of castrate-resistant prostate cancer (PCa).: The basic principles of PCa molecular imaging are illustrated, with a particular attention to the combined use of diagnosis and therapy in a unique approach (the so-called theranostics) for response prediction and assessment in patients submitted to 223Ra-dichloride or PSMA-targeted therapies. In this perspective, the potential of radiomics, an emerging discipline based on the extraction of quantitative features from medical images, is covered.: Theranostic metabolic and molecular probes have been successfully applied to predict and monitor response to radionuclide-based therapies. In particular, both 99mTc-MDP and 18F-NaF resulted useful tools for personalized dosimetry and prognostic stratification before 223Ra-therapy, while PSMA-ligands, alone or in combination with 18F-FDG, provided valuable information to select patients who are more likely to benefit from RLT and getting information on PCa grade of differentiation and aggressiveness. In spite of its high potential, PET-radiomics for PCa is still at an embryonic phase and needs further validation.