Next-Generation Imaging

The Society of Nuclear Medicine and Molecular Imaging announced a consensus statement on patient selection and appropriate use of the radionuclide therapy 177Lu-PSMA-617 in patients with prostate cancer.

Cohort 3 of the SECuRE trial is exploring the safety and efficacy of a single-dose administration of 12GBq 67Cu SAR-bisPSMA in patients with metastatic castrate-resistant prostate cancer.

"We found that urology practices increasingly using mpMRI, and tissue-based genomics to a lesser extent, are more likely to treat men who have a high risk of non-cancer mortality. These men have the least to gain from treatment and are likely being overtreated,” says Kassem S. Faraj, MD, MS.

Use of non-contrast MRI also showed the potential to decrease identification of clinically insignificant disease.

The prospective, open-label, phase 2 SOLAR study enrolled 26 patients with metastatic prostate cancer.

“The results of the current study indicate that 100% of the elderly patients who were referred for PSMA PET/CT on the basis of clinical suspicion only were found to have avid disease," said Einat Even-Sapir, MD, PhD.

The SECURE trial exploring 64Cu/67Cu SAR-bisPSMA in patients with metastatic castration-resistant prostate cancer has advanced to the highest dose level.

A recent study suggests that combined use of ultrasound and multiparametric MRI-targeted biopsy with systematic biopsy may be more effective for detecting clinically significant prostate cancers than using systematic biopsies alone

"In patients with prostate cancer considered for surgery, PSMA-PET can provide information on the risk of recurrence after surgery, before the surgery even happens," says Loïc Djaïleb, MD, PhD.

Even in the era of PSMA-PET imaging, whole-body low-dose computed tomography still offers value in the management of patients with prostate cancer, according to a study published in Insights into Imaging.

The approval comes after a recommendation for marketing authorization from the European Medicines Agency’s Committee for Medicinal Products for Human Use in May 2023.

“These findings suggest that the technical advantages of precision of radiotherapy delivery afforded by MRg-A-SBRT translate to measurable clinical benefit,” wrote lead study author Jonathan E. Leeman, MD.

Flotufolastat F 18 is now included in the NCCN prostate cancer guideline recommendations for all the same categories as the other PSMA-PET imaging agents approved by the FDA.

The SABRE trial is exploring the PET-imaging agent 64Cu SAR-Bombesin in patients with PSMA-negative biochemically recurrent prostate cancer following definitive therapy.

Researchers may be able to use imaging mass cytometry to capture and classify the tumor-immune evasion cell networks in clear cell renal cell carcinoma.

Analysis shows MRI is comparable to post-surgery pathologic staging for assessing risk of biochemical recurrence.

“I think the prostate cancer community has benefited a lot in the past several years with the advent of enhanced imaging tools to help us better stage patients with prostate cancer both at their initial diagnosis and if, unfortunately, they have a recurrence,” says Edward M. Schaeffer, MD, PhD.

The study will assess the ability of Cu-64 SAR-bisPSMA to detect prostate cancer within the pelvic lymph nodes.

"The high reproducibility of reader results across all regions is clinically valuable, with the potential to influence patient management prior to surgery for patients with newly diagnosed disease," says Phillip H. Kuo, MD, PhD.

"Personalized dosing allowed one-third of the men in this study to have treatment breaks while still achieving the same progression-free and overall survival outcomes they would have if they received continuous treatment," says Andrew Nguyen, MBBS, FRACP, AANMS.

"I think one of the key things is when we look at things like sensitivity and specificity, sensitivity is very much reliant on the incidence of a disease or the state of the disease," says Brian F. Chapin, MD.

“Our results support the notion that mpMRI is an inadequate screening tool for locally advanced [prostate cancer] and should not be used as the sole means of presurgical [prostate cancer] staging," wrote the authors.

The AI model was accurate and effective in an independent test set, according to the study authors.

Flotufolastat F 18 was granted FDA approval on May 25, 2023 based on data from the phase 3 SPOTLIGHT and LIGHTHOUSE trials.

The theranostic 64Cu/67Cu-SAR-BBN combines the imaging product 64Cu-SAR-BBN and the targeted therapy 67Cu-SAR-BBN.

“It's very helpful when we're looking at how we counsel patients about the stage of their disease,” says Brian F. Chapin, MD.

Pelvic lymph node involvement and polymetastases detected with PSMA-PET imaging were linked to significantly lower overall survival rates in patients initially diagnosed with non-metastatic, castration-resistant prostate based on conventional imaging.

“I think the importance of this is that these are more accurate than our current imaging studies in helping us to better counsel patients on the expected treatment options given their current situation,” says Brian F. Chapin, MD.

“Obviously it's important to have options when we're looking at the various tracers that we're using for evaluation of patients with prostate cancer,” says Brian F. Chapin, MD.

The approval of flotufolastat F 18 (formerly 18F-rhPSMA-7.3) in prostate cancer is based on findings from the phase 3 SPOTLIGHT and LIGHTHOUSE trials.