Abstract
Simple SummaryImaging plays a crucial role in the accurate staging of prostate cancer. Prostate-specific membrane antigen (PSMA) is overexpressed in prostate cancer cells, and targeting the PSMA protein for diagnostic purposes has become of great clinical value. Another valuable feature of PSMA is its opportunity to serve as a target for delivering radionuclide therapy to cancer cells. PSMA-ligands can be labeled with various radionuclides, such as alpha and beta-emitters. This review offers an overview of the literature on recent developments in nuclear medicine regarding PSMA in prostate cancer diagnostics and targeted radionuclide therapy.Targeting the prostate-specific membrane antigen (PSMA) protein has become of great clinical value in prostate cancer (PCa) care. PSMA positron emission tomography/computed tomography (PET/CT) is increasingly used in initial staging and restaging at biochemical recurrence in patients with PCa, where it has shown superior detection rates compared to previous imaging modalities. Apart from targeting PSMA for diagnostic purposes, there is a growing interest in developing ligands to target the PSMA-protein for radioligand therapy (RLT). PSMA-based RLT is a novel treatment that couples a PSMA-antibody to (alpha or beta-emitting) radionuclide, such as Lutetium-177 (177Lu), to deliver high radiation doses to tumor cells locally. Treatment with 177Lu-PSMA RLT has demonstrated a superior overall survival rate within randomized clinical trials as compared to routine clinical care in patients with metastatic castration-resistant prostate cancer (mCRPC). The current review provides an overview of the literature regarding recent developments in nuclear medicine related to PSMA-targeted PET imaging and Theranostics.
Highlights
Prostate cancer (PCa) is the second-most common malignancy worldwide, and it is the fifth leading cause of cancer-related mortality among men [1]
This review summarizes the current literature on the recent developments in nuclear medicine regarding prostate-specific membrane antigen (PSMA) in PCa diagnostics and targeted radionuclide therapy
Recent studies have demonstrated the advantages of PSMA positron emission tomography/computed tomography (PET/computed tomography (CT)) in the primary staging of men with PCa compared to conventional imaging modalities [8,16,19,20,28]
Summary
Prostate cancer (PCa) is the second-most common malignancy worldwide, and it is the fifth leading cause of cancer-related mortality among men [1]. Imaging plays a pivotal role in assessing the disease extent, through targeting the prostate-specific membrane antigen (PSMA) [4]. Aside from targeting the PSMA protein for diagnostic purposes, there is an increasing interest in using PSMA-radioligands for therapeutic purposes This approach is called radioligand therapy (RLT). PSMA-RLT combines PSMA-ligands and therapeutic radionuclides to deliver targeted high radiation doses to cancer cells, leading to cellular death. This review summarizes the current literature on the recent developments in nuclear medicine regarding PSMA in PCa diagnostics and targeted radionuclide therapy. Current international guidelines recommend multiparametric magnetic resonance imaging (mpMRI) in patients with an elevated PSA before prostate biopsy, allowing the targeted biopsy of suspicious radiological lesions [3]. The use of PSMA PET/CT for the initial staging of patients with high-risk PCa has been recognized based on the results of several prospective studies [15,16]
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