前列腺癌（PCa）是老年男性中第二常见的恶性肿瘤，数据显示约90%的患者在晚期阶段合并骨转移，严重影响患者的生活质量及预期寿命。PCa骨转移的生物学特性与骨重塑异常和骨病理变化密切相关。目前针对晚期PCa临床主要有雄激素剥夺治疗（ADT）联合新型内分泌治疗、放化疗及新型的核素治疗等，其中核素治疗通过药物输送载体将核素精准递送至全身肿瘤病灶，实现精准打击等优势开启了晚期PCa合并骨转移治疗新篇章。核素⁸⁹Sr与¹⁵³Sm可缓解PCa骨转移疼痛，²²³Ra在多种联合治疗研究中展示了潜在的生存获益，¹⁷⁷Lu-PSMA、²²⁵Ac等新型核药的联合应用，打开了晚期PCa患者的治疗新格局。本文总结了核素在晚期PCa合并骨转移患者治疗中的最新进展，为临床治疗提供系统认识和新思路。

Prostate cancer (PCa) is the second most common malignancy in elderly men. Data indicate that approximately 90% of patients develop bone metastases in the advanced stage, significantly impairing quality of life and life expectancy. The biological characteristics of PCa bone metastases are closely associated with abnormal bone remodelling and pathological bone changes. Current clinical approaches for advanced PCa primarily include androgen deprivation therapy (ADT) combined with novel endocrine therapies, radiotherapy and chemotherapy, and novel radionuclide therapies. Among these, radionuclide therapy delivers radionuclides precisely to systemic tumour sites via drug delivery vehicles, offering advantages such as targeted treatment and initiating a new era in managing advanced PCa with bone metastases. ⁸⁹Sr and ¹⁵³Sm alleviate pain associated with PCa bone metastases, while ²²³Ra has demonstrated potential survival benefits in multiple combination therapy studies. The combined application of novel radiopharmaceuticals such as ¹⁷⁷Lu-PSMA and ²²⁵Ac has reshaped the therapeutic landscape for patients with advanced PCa. This article summarises recent advances in radionuclide therapy for patients with advanced PCa and bone metastases, providing systematic insights and novel perspectives for clinical practice.