Development of Prostate Specific Membrane Antigen (PSMA)-targeted radiopharmaceuticals for theranostics has changed the treatment landscape for patients with metastatic castration-resistant prostate cancer (mCRPC). The emerging use of [225Ac]Ac-PSMA-RLT has been effective and safe for the treatment of mCRPC. Nevertheless, challenges with the nuclear recoil of [225Ac]Actinium radionuclides, which may release the daughter radionuclide from the radiopharmaceutical and lead to unnecessary irradiation of other organs, poses threats such as organ dysfunction. Therefore, this short communication aims to highlight the current situation in Malaysia and explain the solutions by using a risk-based approach analysis for the inhouse preparation.