The European Association of Nuclear Medicine (EANM) has joined as co-organizer of the European Multidisciplinary Congress on Urological Cancers (EMUC26), making it the first time nuclear medicine has sat at the organizing table of Europe's leading urological cancer congress.
EMUC26 takes place 5–8 November 2026, in Brussels (abstract submissions are open until 1 August 2026). It is jointly organized by the European Association of Urology (EAU), the European Society of Radiology (ESR), the European Society for Radiotherapy and Oncology (ESTRO), and now EANM.
PSMA PET/CT has reshaped prostate cancer detection and staging over the past decade, while radioligand therapies such as lutetium-177 PSMA-617 have expanded treatment options for patients with advanced disease. With EANM co-organizing, molecular imaging and theranostics will be represented across the congress program, including case discussions, courses, and workshops.
"This is a significant step in strengthening multidisciplinary collaboration on urological cancer management," said EANM President Paola Anna Erba in a press release. "As a co-organizer of the congress, EANM is committed to promoting more precise and integrated approaches to diagnosis, treatment, and outcomes of urological cancers."
In 2026, EANM will also open a new office in Brussels, in partnership with the ESR, with EANM's Head of EU Affairs, Amélie de Martini, already based there. In its November 2025 announcement, EANM described the move as a milestone in its strategic engagement with EU institutions, citing ongoing legislative processes including the EU pharmaceutical legislation revision, the implementation of the new European HTA system, and the future of radioisotope supply chains.
The access problem nobody is measuring
According to the EANM EU Affairs Report 2026, nuclear medicine is not systematically captured in EU-level tools such as the Cancer Inequalities Registry, the primary EU tool for tracking disparities in cancer care across member states. EANM states this means there is no systematic EU-level data on how unevenly theranostics is distributed across Europe.
A patient in Germany or the Netherlands has access to PSMA PET/CT and lutetium-177 PSMA-617 as part of routine care. A patient in a smaller member state, or in a rural region of a larger one, may face a very different reality, but the scale and geography of that divide is not formally measured anywhere. Without data, the disparity is invisible to policymakers, and the existing patchwork of national reimbursement decisions, isotope logistics constraints, and workforce shortages continues to compound.
A U.S. study published April 29, 2026 (read the whole AuntMinnie report) in the Journal of the American College of Radiology (JACR) quantified a comparable access gap in a different health system context. Researchers at the Harvey L. Neiman Health Policy Institute found that when gallium-68 DOTATATE/DOTATOC PET replaced Octreoscan for neuroendocrine tumor imaging in 2017, rural patients were forced to travel on average 134.9 additional miles to access the scan, compared with only 26.7 additional miles for urban patients.
The gap arose directly from the isotope's 68-minute half-life, which requires local production. It narrowed after copper-64 DOTATATE, with its longer 12.7-hour half-life, entered the market in 2021.
The European situation is structurally harder. The U.S. has a single regulatory framework and a relatively consolidated supply chain. Europe has 27 national frameworks, fragmented reimbursement systems, and isotope production concentrated in a small number of aging research reactors. Short half-life radiopharmaceuticals do not travel well across borders.
An outdated regulatory framework
The EU Basic Safety Standards Directive was last consolidated in 2013. The main EU pharmaceutical legislation predates modern radioligand therapy. According to EANM, this has resulted in a regulatory framework with frequent misalignment between pharmaceutical and radiation safety rules, creating administrative complexity that falls disproportionately on academic research centers and hospital radiopharmacies, according to EANM policy material.
EANM identifies various primary structural barriers facing the field in Europe: fragmented legislation, limited multidisciplinary collaboration, supply chain vulnerabilities, and infrastructure constraints, compounded by funding limitations, digital transformation demands, data governance requirements, and sustainability pressures.
The pharmaceutical legislation battle
In April 2024, the European Parliament voted in favor of the reform of the EU pharmaceutical legislation with, according to Nuclear Medicine Europe, only minimal recognition of the nuclear medicine field. In a joint statement, EANM and Nuclear Medicine Europe said that the amendments they had prepared together were not accepted.
In December 2025, EANM acknowledged reports of a provisional political agreement between the European Parliament and the Council on the revised legislation, while noting the text had not yet been made publicly available and that formal adoption remains pending. EANM said it would review both the regulation and directive once published and share detailed information with the nuclear medicine community on the regulatory changes affecting radiopharmaceuticals.
The legislation is now awaiting approval by the European Parliament and Council before publication in the EU Official Journal. Separately, the European Medicines Agency is developing complementary guidelines on radiopharmaceuticals that EANM has said may contribute to more tailored regulatory pathways.
Reimbursement: The wall between approval and access
EMA approval does not automatically trigger reimbursement in any EU member state. Each country negotiates separately, using its own Health Technology Assessment (HTA) methodology and timeline.
According to EANM's EU Affairs Report 2026, Europe's fragmented reimbursement and access pathways remain a major barrier to timely and equitable patient care. EANM calls for a more coordinated interface between EU-level scientific assessment and national market-access processes.
As the new European HTA system is implemented, EANM is advocating for assessment methodologies that incorporate nuclear medicine expertise and allow for flexible evidence requirements, on the grounds that radioligand therapies involve unique clinical pathways, trial designs, and multistep production realities that differ from conventional pharmaceuticals.
The global theranostics market is projected to grow from $6.97 billion in 2024 to $11.06 billion by 2034, according to industry estimates cited in the EMA/HMA April 2025 supply chain recommendations.
Personalized medicine: The science behind it
Personalized dosimetry is legally mandated under Euratom directives and formally recommended by EANM, SNMMI, and the IAEA. A randomized multicenter phase II trial, DOSISPHERE-01, published in Lancet Gastroenterology and Hepatology in 2021, found that personalized dosimetry significantly improved objective response rates compared with standard dosimetry in patients with locally advanced hepatocellular carcinoma. Long-term follow-up data published in the Journal of Nuclear Medicine in 2024 confirmed sustained improvement in overall survival.
EANM has called for increased EU funding for radiobiology and dosimetry research, and for translational radioligand therapy research through Horizon Europe and the Innovative Health Initiative.
A supply chain under pressure
On 14 April 2025, the EMA and Heads of Medicines Agencies, through the Executive Steering Group on Shortages and Safety of Medicinal Products, issued formal recommendations to address vulnerabilities in the radiopharmaceutical supply chain. The recommendations called on the European Commission to boost domestic manufacturing capabilities, support EU-based production of high-assay low-enriched uranium, advance the European Radioisotope Valley Initiative, harmonize transport certification procedures, and expand monitoring beyond molybdenum-99/technetium-99m.
The EMA noted that radiopharmaceutical production relies heavily on stable isotopes and materials sourced mainly from China, Russia, and other third countries, and that occasional shortages have already emerged in different EU member states. EANM welcomed the recommendations as having the potential to mitigate the impact of shortages on patients.
Production of lutetium-177, actinium-225, and emerging terbium isotopes is concentrated in a small number of European facilities. The EMA has stated that manufacturing capacity in Europe is limited relative to growing demand.
The Brussels connection
EANM's Policy and Regulatory Affairs Council was established in January 2022 and meets monthly to coordinate the organization's EU-level policy activities. In its announcement of the Brussels office, EANM said the physical presence would allow it to deepen engagement with EU policymakers and stakeholders on key initiatives including Europe's Beating Cancer Plan, the European Cardiovascular Health Plan, and pharmaceuticals-related legislation.
EANM Annual Congress 2026 takes place in Vienna in October 2026. EMUC26 follows in Brussels in November, with EANM now at the organizing table for the first time.
