A French early-access program reported real-world outcomes for 177Lu-PSMA-617 in metastatic castration-resistant prostate cancer across 3,709 patients, reporting efficacy and safety patterns broadly aligned with the VISION trial. The analysis reported 7.6 months median progression-free survival and disease control in 82% of patients, positioning the therapy as operationally deployable outside strictly controlled trial settings. The cohort’s scale is a major differentiator, offering a closer look at how PSMA radioligand therapy performs in routine practice with heterogeneous patient characteristics. The findings also feed payer and guideline discussions where clinicians increasingly weigh real-world performance when considering access. For biotech and commercial teams, the key signal is that community settings can replicate large-trial endpoints closely enough to reduce perceived execution risk—supporting broader adoption of PSMA-based theranostics in the prostate cancer market.