<p>Theranostics, the combined use of radiopharmaceuticals for diagnosis and therapy, has seen a significant evolution, accelerated by its application in prostate cancer. While this field has grown exponentially over the past decade, its implementation remains fraught with challenges, especially in developing countries. These challenges span three stages: pre-establishment, establishment, and post-establishment of theranostics centers. This article explores these obstacles and offers insights into overcoming them. In the pre-establishment phase, key barriers include limited government funding, lack of administrative support, and personal risks. During establishment, multitasking, the absence of trained personnel, and resource shortages are prominent hurdles. Post-establishment trials include overcoming colonial mentality, limited patient access due to financial constraints, logistical difficulties, and a lack of research capacity, among others. Despite these tests, successful establishment of theranostics centers is possible through strong leadership, rigorous training, international collaboration, and a patient-centered approach. The experience of the Philippines illustrates that, while the road is challenging, it is ultimately achievable with clear vision, unrelenting dedication, and the stakeholders’ cooperation.</p>