Prostate surface membrane antigen (PSMA) is usually overexpressed in prostate cancer (PC) and is enriched in castration-resistant tumors. PSMA-TRT is of increasing interest in the field. Many in the field of theranostics have assumed that PSMA uptake on imaging is a pre-requisite for response. We have conducted a number of trials which have incorporated PSMA imaging, but have not selected patients for treatment based upon imaging results and performed an analysis examining the relationship between imaging and response.