Sustainability aspects were taken into account from the outset of the PRISMAP project, with the overall objective being to establish the European medical radionuclides programme on a long-term. After approximately five years of implementing and developing PRISMAP, the European and international landscape, as well as that of nuclear medicine and radiopharmaceuticals, has evolved to a degree that far exceeds the most optimistic forecasts made when PRISMAP was first developed. In this document, we present the various aspects taken into account in the sustainability of PRISMAP, with an important milestone being the submission of a new PRISMAP+ project proposal aimed at providing a structure for the period 2026-2029, as a new phase of the European medical radionuclides programme, in order to connect with the evolving landscape of cutting-edge European research in nuclear medicine.