PurposeThis study is to investigate the adoption and current trends of Lutetium-177PSMA RLT for mCRPC in Germany.MethodsWe analyzed data from the reimbursement.INFO tool based on German hospitals’ quality reports for Lutetium-177PSMA RLT from 2016 to 2020 and from the nationwide German hospital billing database (Destatis) for general therapy with open radionuclides in combination with prostate cancer from 2006 to 2020. For validation of these billing data, we included the177Lu-PSMA RLT cycles from two participating institutions from 2016 to 2020. For detection of trends over time we applied linear regression models.ResultsGeneral therapy with open radionuclides increased from 2006 to 2020. We identified a total of 12,553177Lu-PSMA RLT cycles. The number of177Lu-PSMA RLTs steadily increased from a total of 1026 therapies in 2016 to 3328 therapies in 2020 (+ 576 RLT/year;p< 0.005). In 2016, 25 departments of nuclear medicine offered this treatment, which increased to 44 nuclear medicine departments in 2020. In 2016, 16% of nuclear medicine departments (4/25) performed more than 100177Lu-PSMA RLTs, which increased to 36% (16/44) in 2020 (p< 0.005). In 2016, 88% (22/25) of 177Lu-PSMA RLTs were performed at a university hospital, which decreased to 70% (31/44) in 2020. The proportion of patients older than 65 years receiving177Lu-PSMA RLT increased from 78% in 2016 to 81% in 2020.ConclusionTreatment of mCRPC with177Lu-PSMA RLT has been rapidly increasing in Germany in the recent years providing an additional therapy option. This development is remarkable, because of outstanding formal EMA approval.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00259-023-06139-x.