The current status of prostate cancer treatment and PSMA theranostics

Abstract

In the treatment of cancer, understanding the disease status, or accurate staging, is extremely important, and various imaging techniques are used. Computed tomography (CT), magnetic resonance imaging, and scintigrams are commonly used for solid tumors, and advances in these technologies have improved the accuracy of diagnosis. In the clinical practice of prostate cancer, CT and bone scans have been considered especially important for detecting metastases. Nowadays, CT and bone scans are called conventional methods because positron emission tomography (PET), especially prostate-specific membrane antigen (PSMA)/PET, is extremely sensitive in detecting metastases. Advances in functional imaging, such as PET, are advancing the diagnosis of cancer by allowing information to be added to the morphological diagnosis. Furthermore, PSMA is known to be upregulated depending on the malignancy of the prostate cancer grade and resistance to therapy. Therefore, it is often highly expressed in castration-resistant prostate cancer (CRPC) with poor prognosis, and its therapeutic application has been attempted for around two decades. PSMA theranostics refers to a type of cancer treatment that combines both diagnosis and therapy using a PSMA. The theranostic approach uses a radioactive substance attached to a molecule that targets PSMA protein on cancer cells. This molecule is injected into the patient’s bloodstream and can be used for both imaging the cancer cells with a PET scan (PSMA PET imaging) and delivering radiation directly to the cancer cells (PSMA-targeted radioligand therapy), with the aim of minimizing damage to healthy tissue. Recently, in an international phase III trial, the impact of 177Lu-PSMA-617 therapy was studied in patients with advanced PSMA-positive metastatic CRPC who had previously been treated with specific inhibitors and regimens. The trial revealed that 177Lu-PSMA-617 significantly extended both progression-free survival and overall survival compared to standard care alone. Although there was a higher incidence of grade 3 or above adverse events with 177Lu-PSMA-617, it did not negatively impact the patients’ quality of life. PSMA theranostics is currently being studied and used primarily for the treatment of prostate cancer, but it has the potential to be applied to other types of cancers as well.

Hotspots and frontiers in PSMA research for prostate cancer: a bibliometric and visualization analysis over the past 20 years

“…A lag between the two categories suggested although PSMA has become a star molecule in the field of nuclear medicine, increasing evidence suggests the high sensitivity of PSMA-targeted imaging and the effectiveness of PSMA RLT for PCa. However, the manner and timing of its application in tumor patients are currently undergoing intensive testing within the oncology field [ 27 – 29 ]. The prosperity in publications and research in the field of nuclear medicine is poised to provide a deeper understanding of the mechanisms behind PSMA-targeted therapy and imaging, thereby potentially providing widespread benefits to all PCa patients.…”

Hotspots and frontiers in PSMA research for prostate cancer: a bibliometric and visualization analysis over the past 20 years

“…A lag between the two categories suggested although PSMA has become a star molecule in the eld of nuclear medicine, increasing evidence suggests the high sensitivity of PSMA-targeted imaging and the effectiveness of PSMA RLT for PCa. However, the manner and timing of its application in tumor patients are currently undergoing intensive testing within the oncology eld (27)(28)(29). The prosperity in publications and research in the eld of nuclear medicine is poised to provide a deeper understanding of the mechanisms behind PSMA-targeted therapy and imaging, thereby potentially providing widespread bene ts to all PCa patients.…”

Current Status of Prostate-specific Membrane Antigen-targeted Alpha Radioligand Therapy in Prostate Cancer

“…Although PSMA is rarely expressed in normal human prostate epithelial cells, its expression in most PCa cells can exceed that in normal prostate epithelial cells by up to 100-1000 times (16,17). Furthermore, PSMA overexpression is more prevalent in prostate cancers with a high Gleason score and in cases progressing to castration resistance (18,19). Another specific aspect associated with PSMA expression is the internalization process in which proteins bound to PSMA on the cell surface undergo internalization.…”