A French early-access program of 3,709 patients with metastatic castration-resistant prostate cancer reported that 177Lu-PSMA-617 delivered efficacy and safety outcomes in routine practice that track closely with the VISION trial. Median progression-free survival was 7.6 months, and disease control was reported in 82% of patients, reinforcing the drug’s performance outside tightly controlled trial settings. The analysis adds to the growing body of “real-world plus” evidence regulators and payers increasingly look for when considering radiopharmaceutical diffusion into standard care. It also highlights that operational deployment can reproduce trial-like outcomes when centers follow established protocols. For oncologists, the data provide another reference point when discussing sequencing and expected response durability for patients treated beyond initial trial populations.