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The aim of the study was to assess the outcome of patients with metastatic castration-resistant prostate cancer treated with 177Lu-prostate-specific membrane antigen (PSMA) who would have been a screen failure (SF) in the VISION trial based on PSMA PET/CT criteria. Methods We conducted a retrospective multicenter cohort study on 301 patients with metastatic castration-resistant prostate cancer treated with 177Lu-PSMA. The patients were classified into eligible (VISION-PET-E) and SF (VISION-PET-SF) groups on the basis of the baseline PSMA PET/CT results. Pro