Next-Generation 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.

“PSMA-PET technology is helping urologists think about how to individualize a treatment plan for a patient based on what's discovered with this sensitive imaging modality,” says Christopher W. Ryan, MD.

The theranostic 64Cu/67Cu SAR-bisPSMA yielded positive safety and efficacy signals in patients with metastatic castration-resistant prostate cancer.

“PSMA-PET imaging gives us a more nuanced approach by giving us more accurate information,” says Jen-Jane Liu, MD.

Jen-Jane Liu, MD, discusses how PSMA-PET imaging might help physicians decide whether or not a patient with prostate cancer needs lymph node dissection.

Researchers examined the impact of deep learning–based AI software upon radiologists reviewing multiparametric MRI scans in the assessment of clinically significant prostate cancer.

In the ARASTEP trial, the primary outcome measure of rPFS is being measured by PSMA-PET/CT imaging with 68Ga-PSMA-11 (prepared using Illuccix) or piflufolastat F 18.

Illuccix is approved by Health Canada for imaging in patients with suspected metastasis who are candidates for initial definitive therapy, or in patients with suspected recurrence based on an elevated PSA level.

The designation is for patients with mCRPC who have progressed on an androgen receptor pathway inhibitor and are not eligible for or decline to receive chemotherapy.

Scott T. Tagawa, MD, discusses trials exploring 177Lu-PSMA-617 in settings earlier than it’s FDA-approved indication for patients with heavily pretreated metastatic castration-resistant prostate cancer.

The tool uses a tumor-to-salivary gland ratio (PSG score) to predict outcomes.

TLX250-CDx PET/CT demonstrated a high degree of sensitivity (85.5%) and specificity (87.0%) for detection of clear cell renal cell carcinoma in patients with indeterminate renal masses.

The PSMA-targeted fluorescent tracer OTL78 was shown to be safe and enabled real-time imaging during robot-assisted radical prostatectomy and provided valuable information on the localization and extent of prostate cancer.

Clinical guidelines currently do not recommend PSMA-PET imaging before radical prostatectomy.

“What we need now are biomarkers to know if the medication is going to work or not,” says Park.

The deep learning software also showed no difference in the consistency of scoring with the Prostate Imaging-Reporting and Data System (PI-RADS).

"Where it's feasible and where the patients are eligible, I and others are trying to use alternative therapies, which have probably a similar impact in terms of improving longevity of life for patients [with prostate cancer]," says Praful Ravi, MD, BChir, MRCP.

"Some of these patients newly referred don't have any other proven therapies remaining...This is the only one on the shelf that has a proven benefit. Unfortunately, we can't offer them that at this stage," says Praful Ravi, MD, BChir, MRCP.

The PSMA-targeted monoclonal antibody J591 is effective in non-metastatic CRPC when it is radiolabeled with either 177Lu or 111In.

Antibody-drug conjugates, including those targeting PSMA, are among the next wave of treatment advances in mCRPC.

The PSMA-PET imaging product is now approved for the selection of patients with metastatic prostate cancer for whom 177Lu-PSMA-617 is indicated.

Once patients had a PSA level of 0.25 ng/mL or higher, the risk of mortality increased by approximately 50%.

The phase 1 PROPELLER trial assessed the safety and efficacy of 64Cu-SAR-bisPSMA, and compared the imaging agent with 68Ga-PSMA-11 PET.