Prostate‐specific membrane antigen theranostics in advanced prostate cancer: an evolving option

Abstract

To review current data for the role of prostate specific membrane antigen (PSMA) radioligand therapy (RLT) for patients with advanced prostate cancer. This review provides an update for multidisciplinary teams on the current and potential future applications of theranostics in prostate cancer. Methods Narrative review focussing on PSMA as a target for RLT, and data using Results RLT with PSMA is an exciting therapeutic alternative to the existing management options already in use for patients with metastatic castrate-resistant prostate cancer (mCRPC). To date, most evidence exists regarding small-molecule PSMA inhibitors bound to beta-emitting radioisotopes such as 177Lu (Lu-PSMA). Prospective phase II data supports the safety and efficacy of Lu-PSMA in men with heavily pre-treated progressive mCRPC, and several late-phase randomised trials of Lu-PSMA are underway, with many more in the pipeline. Early results are encouraging, indicating that the theranostic approach may play a vital role in management of advanced prostate cancer and perhaps even in much earlier disease states. Conclusions PSMA RLT is a promising new treatment option for men with mCPRC, and may also have utility in less advanced prostate cancer.

UpFrontPSMA: a randomized phase 2 study of sequential 177Lu‐PSMA‐617 and docetaxel vs docetaxel in metastatic hormone‐naïve prostate cancer (clinical trial protocol)

“…Importantly, PSMA serves as an opportune target for radioligand therapy, for example, using lutetium-177 ( 177 Lu)-PSMA-617. PSMA overexpression has been observed in poorly differentiated and castration-resistant metastatic carcinoma [10,11] as well as in high-risk localized disease, supporting a role for PSMA radioligand therapy, including at earlier disease stages [8,[12][13][14]. PSMA rapidly internalizes following binding of ligand, optimizing delivery of radioactive PSMA ligands into cancer cells [15].…”

“…There is accumulating evidence of 177 Lu-PSMA-617 activity and safety in men with mCRPC [13]. Docetaxel and novel androgen receptor-targeting agents have shown impressive efficacy when used in mHNPC.…”

Tumor-Specificity Growth Factor Combined with Tumor Markers in Nuclear Medicine Imaging to Identify Prostate Cancer Osteonosus

“…It has very clear characteristics of osseous metastasis. Among patients with anterior lacrimal gland, 70% of patients suffer from bone metastases [ 5 ]. These characteristics will cause the upregulation of the expression of bone formation-related molecules, suggesting that osteoclasts are also involved in the formation of osteoblast metastases.…”

Theranostic Advances in Breast Cancer in Nuclear Medicine

“…The two prevalent ligands for NET are DOTA-Phe1-Tyr3-octreotide (DOTA-TOC) and DOTA-DPhe1,Tyr3-octreotate (DOTA-TATE) widely used worldwide [ 36 , 37 , 38 , 39 ]. Aside from the encouraging efficacy and safety of PSMA-617, PSMA-11 and PSMA-I&T for clinical assessment of PC, efforts are ongoing towards finding unpresented radiotheranostics with better capabilities [ 40 , 41 , 42 , 43 ]. Gene expression profiling for prognostic and predictive issues in BC has been received considerable attention in clinic recently [ 7 ].…”