Next-Generation Imaging

“We now have convincing evidence that these tests help identify more sites of prostate cancer," said Michael Leapman, MD.

Using MRI-directed targeted biopsy instead of systematic biopsy for screening and early detection in patients with an elevated PSA lowered the risk of overdiagnosis by half.

64Cu-SAR-bisPSMA was, “safe, well tolerated, and efficacious in detecting primary prostate cancer,” according to developer Clarity Pharmaceuticals.

“In terms of both numbers of centers [administering radionuclides] as well as the amount of drug that’s available, [both] are going to increase over the next several months and certainly, year,” says Scott T. Tagawa, MD, MS, FACP.

177Lu-PSMA-617 is approved for the treatment of patients with PSMA-positive metastatic castration-resistant prostate cancer in the post androgen receptor pathway inhibition, post taxane-based chemotherapy setting.

Emerging research includes combining radionuclides with other agents and exploring novel approaches to targeting PSMA, such as antibodies.

“MRI-based screening showed lower proportions of screening-positive cases, lower false positive rates, and higher PPVs [positive predictive values] than those of PSA-based screening,” noted Taek Min Kim, MD.

According to Novartis, the developer of 177Lu-PSMA-617, the PSMAfore study is the first clinical trial of a PSMA-targeted radioligand therapy to demonstrate a clinically meaningful benefit in the pre–taxane-based chemotherapy mCRPC setting.

"The idea that we may have reliable and consistently interpretable tests for these patients is exciting for the future," says Benjamin Lowentritt, MD, FACS.

“As the PSMA-PET market for access has grown, the coverage has actually been better than we anticipated when it first launched,” says David Morris, MD.

“PSMA scanning is definitely a game-changer with regard to imaging in advanced prostate cancer in urology,” says Evan R. Goldfischer, MD.

177Lu-PSMA-617 is approved by the FDA for the treatment of patients with PSMA-positive metastatic castration-resistant prostate cancer in the post androgen receptor pathway inhibition, post taxane-based chemotherapy setting.

The co-primary end points have been achieved in the phase 3 ZIRCON trial exploring the novel PET imaging radiopharmaceutical TLX250-CDx in clear cell renal cell carcinoma.

64Cu SAR-Bombesin targets the Gastrin Releasing Peptide receptor, which is found on prostate tumors as well as several other tumors.

"During treatment with 177Lu-PSMA-617, patients should be counseled to increase oral fluid intake and to void frequently to reduce bladder radiation exposure," writes Stephanie Trexler, PharmD, BCOP.

New findings from the phase 3 SPOTLIGHT trial show the impact of PSA level, PSA doubling time, Gleason score, and prior therapy on 18F-rhPSMA-7.3 detection rates.

A recent study suggests that radiomics analysis based on 68Ga-PSMA-11 PET may non-invasively predict intraprostatic lesions in patients with prostate cancer.

Illuccix is indicated for use in patients with suspected metastasis who are candidates for initial definitive therapy, or in patients with suspected recurrence based on elevated PSA level.

“I think that we’re going to see more and more advances in how we use mpMRI from a pre-treatment planning perspective,” William P. Parker, MD.

The target of 64Cu SAR-Bombesin is the Gastrin Releasing Peptide receptor, which is found on prostate tumors as well as several other tumors.

“From a screening perspective, mpMRI really has changed how we evaluate men at risk for prostate cancer. It has improved the selection of men for biopsy and certainly improved our diagnostic rates,” says William P. Parker, MD.

"HP 13C MRI provides a quick five-minute, non-radioactive, metabolic imaging add-on exam to standard-of-care MRI that, in conjunction with guided biopsies, has great potential to improve the care of prostate cancer patients,” said Robert Bok, MD, PhD.

The application is supported by findings from a phase 1 trial and two phase 3 trials, SPOTLIGHT and LIGHTHOUSE.

The phase 2 ProstACT TARGET study is exploring TLX591 (177Lu-DOTA-rosopatamab) in combination with external beam radiation therapy.

William P. Parker, MD, highlights 3 areas in which he thinks PSMA-PET imaging is going to be explored further in prostate cancer.

There are 2 FDA-approved PSMA-PET imaging agents: Gallium 68 PSMA-11 (Ga 68 PSMA-11) and piflufolastat F 18.

In this interview, William P. Parker, MD, highlights the development of PSMA-PET imaging in prostate cancer, FDA-approved PSMA-PET agents, and the next steps with this disruptive technique.

“PSMA-PET imaging is something that from a clinical practice perspective is rapidly changing and evolving the field of prostate cancer,” says William P. Parker, MD.

The target of 64Cu SAR-Bombesin is the Gastrin Releasing Peptide receptor, which is found on prostate tumors as well as several other tumors.

Experts weigh in on whether the combined technologies could be the future power couple of prostate cancer diagnosis.