Neoadjuvant Lu-177-PSMA-617 in Patients With High Risk Localized Prostate Cancer Undergoing Radical Prostatectomy

Inclusion Criteria: * Patients age 18 or older. * Patients with histologically confirmed adenocarcinoma of the prostate. * Patients with high-risk disease defined as a preoperative prostate biopsy of Gleason Score 8 (GS8) (Grade group 4 \[GG4\]) or higher. Men with evidence of lymph node involvement at or below the bifurcation of the common iliac arteries (cN1) on PET-CT 68Ga-PSMA-11 are eligible. * Pre-operative, pre-treatment PSMA scan with high expression in prostate confirmed by PET/CT 68Ga-PSMA-11 (greater than liver). Patients must not have any other PET FDG-positive sites outside the prostate. * Patients who are able and willing to undergo surgery. * Patients with a life expectancy of greater than 10 years. Life expectancy can be estimated using any 1 of the following tools: * The Social Security Administration tables: https://www.ssa.gov/OACT/STATS/table4c6.html * The WHO's Life Tables by country: https://apps.who.int/gho/data/view.main.60000?lang=en * The Memorial Sloan Kettering Male Life Expectancy tool: https://www.mskcc.org/nomograms/prostate * If using a life expectancy table, life expectancy should be adjusted using the clinician's assessment of overall health as follows: best quartile of health - add 50%; worst quartile of health - subtract 50%; and middle two quartiles of health - no adjustment. See the NCCN Prostate Cancer Guidelines for more information. * Patients with an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2. …