In this comprehensive narrative review, we examine the landscape of high-risk localized PCa, explain the rationale for a neoadjuvant approach, detail the mechanism and evidence supporting 177Lu-PSMA-617 RLT, and scrutinize the emerging clinical data, immunomodulatory potential, and future challenges associated with advancing this potent therapeutic modality into a curative-intent setting. The gene discussed is FOLH1; the disease is posterior cortical atrophy.