Next-Generation Imaging

New findings from the phase 3 SPOTLIGHT trial show the impact of PSA level, PSA doubling time, Gleason score, and prior therapy on 18F-rhPSMA-7.3 detection rates.

A recent study suggests that radiomics analysis based on 68Ga-PSMA-11 PET may non-invasively predict intraprostatic lesions in patients with prostate cancer.

Illuccix is indicated for use in patients with suspected metastasis who are candidates for initial definitive therapy, or in patients with suspected recurrence based on elevated PSA level.

“I think that we’re going to see more and more advances in how we use mpMRI from a pre-treatment planning perspective,” William P. Parker, MD.

The target of 64Cu SAR-Bombesin is the Gastrin Releasing Peptide receptor, which is found on prostate tumors as well as several other tumors.

“From a screening perspective, mpMRI really has changed how we evaluate men at risk for prostate cancer. It has improved the selection of men for biopsy and certainly improved our diagnostic rates,” says William P. Parker, MD.

"HP 13C MRI provides a quick five-minute, non-radioactive, metabolic imaging add-on exam to standard-of-care MRI that, in conjunction with guided biopsies, has great potential to improve the care of prostate cancer patients,” said Robert Bok, MD, PhD.

The application is supported by findings from a phase 1 trial and two phase 3 trials, SPOTLIGHT and LIGHTHOUSE.

The phase 2 ProstACT TARGET study is exploring TLX591 (177Lu-DOTA-rosopatamab) in combination with external beam radiation therapy.

William P. Parker, MD, highlights 3 areas in which he thinks PSMA-PET imaging is going to be explored further in prostate cancer.

There are 2 FDA-approved PSMA-PET imaging agents: Gallium 68 PSMA-11 (Ga 68 PSMA-11) and piflufolastat F 18.

In this interview, William P. Parker, MD, highlights the development of PSMA-PET imaging in prostate cancer, FDA-approved PSMA-PET agents, and the next steps with this disruptive technique.

“PSMA-PET imaging is something that from a clinical practice perspective is rapidly changing and evolving the field of prostate cancer,” says William P. Parker, MD.

The target of 64Cu SAR-Bombesin is the Gastrin Releasing Peptide receptor, which is found on prostate tumors as well as several other tumors.

Experts weigh in on whether the combined technologies could be the future power couple of prostate cancer diagnosis.

The novel PET imaging agent 68GA-EMP-100 PET measures c-MET expression in renal cell carcinoma.

The PROPELLER trial is exploring the novel PSMA-PET imaging product 64Cu-SAR-bisPSMA in patients with treatment-naïve, histologically confirmed prostate cancer who are scheduled for radical prostatectomy

The phase 3 ZIRCON trial is assessing TLX250-CDx as a noninvasive tool to identify clear cell renal cell carcinoma in patients with indeterminate renal masses

177Lu-PSMA-617 is FDA-approved for the treatment of patients with PSMA-positive metastatic castration-resistant prostate cancer.

177Lu-PSMA-617 is approved by the FDA for previously treated patients with PSMA-positive metastatic castration-resistant prostate cancer.

Phillip Kuo, MD, PhD, discusses the abstract, “[68Ga]Ga-PSMA-11 PET baseline imaging as a prognostic tool for clinical outcomes to [177Lu]Lu-PSMA-617 in patients with mCRPC: A VISION substudy,” which was presented at the 2022 ASCO Annual Meeting.

Cleveland clinic physicians Rahul Tendulkar, MD, and Steve Huang, MD, provide expert insight on PSMA-PET imaging and explain how it has changed clinical management of patients with prostate cancer.

“These findings from the SPOTLIGHT study showed high inter-reader and intra-reader agreement for interpretation of 18F-rhPSMA-7.3 PET/CT scans in the setting of biochemical recurrence,” said Phillip Kuo, MD, PhD.

"The SPOTLIGHT study [of 18F-rhPSMA-7.3] highlights what I believe is a paradigm shift with its multidisciplinary [collaboration] in prostate cancer," said Mark Fleming, MD.

The target of the the PET-imaging agent 64Cu SAR-Bombesin is the Gastrin Releasing Peptide receptor (GRPr), which is found on prostate tumors as well as several other tumors

The guidelines now include the use of piflufolastat F 18, along with all approved PSMA-PET imaging agents, for the selection of prostate cancer patients to receive PSMA-targeted radioligand therapy.

177Lu-PSMA-617 is FDA-approved for the treatment of patients with PSMA-positive metastatic castration-resistant prostate cancer.

The phase 2 STARLITE 2 trial is exploring the combination of the novel radiopharmaceutical TLX250 (177Lu-DOTA-girentuximab) and nivolumab in patients with advanced renal cell carcinoma.

The ongoing phase 1/2 COBRA trial is exploring the PSMA-PET imaging agent 64Cu SAR-bisPSMA in patients with biochemical recurrence of prostate cancer following definitive therapy.

“Overall, there's no known advantage or disadvantage in a head-to-head trial of either one of these, but I do think they're complementary,” says Scott T. Tagawa, MD, when discussing radium-223 dichloride and lutetium Lu 177 vipivotide tetraxetan.