Abstract
Theranostics, a combination of therapy and diagnostics, is a field of personalized medicine involving the use of the same or similar radiopharmaceutical agents for the diagnosis and treatment of patients. Prostate-specific membrane antigen (PSMA) is a promising theranostic target for the treatment of prostate cancers. Diagnostic PSMA radiopharmaceuticals are currently used for staging and diagnosis of prostate cancers, and imaging can predict response to therapeutic PSMA radiopharmaceuticals. While mainly used in the setting of metastatic, castrate-resistant disease, clinical trials are investigating the use of PSMA-based therapy at earlier stages, including in hormone-sensitive or hormone-naïve prostate cancers, and in oligometastatic prostate cancers. This review explores the use of PSMA as a theranostic target and investigates the potential use of PSMA in earlier stage disease, including hormone-sensitive metastatic prostate cancer, and oligometastatic prostate cancer.
Highlights
Theranostics for Treatment of Theranostics, a combination of therapy and diagnostics, is a field of medicine involving the use of radiopharmaceuticals to both diagnose and treat patients
In addition to the oligometastatic setting, Prostate-specific membrane antigen (PSMA)-targeted radiopharmaceuticals are being investigated in the setting of high risk or intermediate risk localized prostate cancer with high 68 Ga-PSMA expression [58]
The capacity to perform personalized image-based dosimetry [61] in patients treated with PSMA-targeted agents may prove critical in the management of patients with oligometastatic disease
Summary
Theranostics for Treatment of Theranostics, a combination of therapy and diagnostics, is a field of medicine involving the use of radiopharmaceuticals to both diagnose and treat patients. While the term theranostics was only recently coined [1,2], the use of radiopharmaceuticals for this purpose has occurred since the 1940s with the imaging and treatment of hyperthyroidism and differentiated thyroid cancers with radioactive iodine [3]. The ideal theranostic target is both overexpressed in cancer cells and has minimal or no expression in normal tissues, thereby permitting high tumor dose with low toxicity to normal tissues. These agents typically have three distinct parts: a radionuclide (often conjugated by a chelator), a linker, and a ligand that binds with a targeted cancer cell receptor [10,11]. The theranostic product pair works together to identify suitable patients for treatment (diagnostic agent) or treat the patient (therapeutic agent) [10,11]
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