PSMA targeted theranostics have fundamentally transformed the treatment of metastatic prostate cancer. However, PSMA expression is heterogeneous and may decrease with disease progression and under therapeutic pressure. During PSMA & Beyond 2026, a broad range of novel targets and therapeutic platforms was discussed that may overcome these limitations. In this review article, we discuss the biological rationale of emerging targets, compare radioligand therapy (RLT), antibody–drug conjugates (ADCs) and bispecific T cell engagers (BiTEs), and outline the implications for clinical practice and research, with specific attention to the Dutch context.