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.