A large French real-world early-access program reinforced the performance of 177Lu-PSMA-617 in metastatic castration-resistant prostate cancer. The dataset included 3,709 patients, with median progression-free survival reported at 7.6 months and disease control in 82% of patients, closely matching outcomes reported in the VISION trial. The program’s scale matters for adoption because it reflects performance outside tightly controlled trial settings, including broader patient comorbidity and treatment histories. Safety outcomes were described as aligning with prior expectations, supporting feasibility for broader use across oncology centers. The next step for stakeholders will be continued surveillance on long-term safety signals, patient selection criteria, and potential operational constraints affecting radiopharmaceutical throughput.