Experts Naveen Kella, MD, and Dr. Shadi Esfahani, MD, MPH, consider the continued impact of PSMA PET imaging on prostate cancer management and emerging modalities that could revolutionize patient care.
Naveen Kella, MD: We can summarize some of the PSMA [prostate-specific membrane antigen] -based imaging advances in prostate cancer. In your opinion, what do you think are some unmet needs in this space? Are there any emerging modalities or therapies that could improve the treatment and management of this disease? Any advice for your colleagues out there who may be watching?
Shadi Abdar Esfahani, MD, MPH: In general, access to the PSMA PET [positron emission tomography] is the major point that I would like to see…All of the centers and all of the practices could have access to and could use it for the patients, since we know that it has made a very significant impact on the clinical management of our prostate cancer patients. So, having…better access is a major point. This is something that we all need to work on. In terms of the in-house production and also the available resources around us in our own space, it is again something that the industry and also the academic and also the private practice institutions need to work on to provide more accessibility to this PET imaging modality. And everything is improving very fast. But this is the unmet need for all of our patients since PSMA has really changed the shape of our current clinical practice. I wanted to get your insight, Dr Kella, on what you think the emergent needs are and what…we need to do as a community—radiology nuclear medicine, urology, and oncology—on improving the patient care based on the PSMA PET.
Naveen Kella, MD: Thanks, Dr Esfahani. One of the challenges…actually being met right now, is the availability of PSMA PET-CT. Just a couple of years ago, it wasn't possible to really order the test in our community. I run a physician practice, a urology practice, and we were just ordering bone scans pretty much a couple of years ago. And otherwise, fluciclovine studies. And now we're making the change. And...for my colleagues, it's the same sort of issue. The NCCN [National Comprehensive Cancer Network], AUA [American Urological Association], all of them are making it clear that PSMA PET-CT is something to consider, not after conventional imaging, but something you would order first line if it's appropriate for the patient.
What I'm very excited about also is how this is changing management. The studies so far are clear that when providers order tests and are asked, well…do these results change your management decisions? It's amazing how often it is changing decisions, but are those change decisions actually going to affect outcomes for patients? And that's where a lot of study is going to be needed to see if it really does improve patient care. So … next generation imaging...is here...with PSMA PET-CT. But...it'll be interesting. I'm very excited to see if this next generation therapy is going to be the same thing, where it has the potential to replace some of our conventional therapies that we're offering now and [it will] be really interesting to sit down and talk about all of this again in a few years to see how things settle out.
Shadi Abdar Esfahani, MD, MPH: Exactly. And...currently…at different conferences, we are seeing that there are a lot of movements from the industry and also in partnership with different academic institutions…with the new clinical trials, with the new generation of the PSMA-targeted compounds with different biodistribution of the compounds and also a lot of combination therapy clinical trials. All of them are being moved forward based on the PSMA PET and what we see at baseline for these patients who get enrolled into these trials. So, it is also very interesting to see how the patient care and the treatment paradigm [will] shift over the next decade or so.
Naveen Kella, MD: Right. Well, thank you very much. I really enjoyed having this discussion with you today, Dr Esfahani.
Shadi Abdar Esfahani, MD, MPH: Me as well. Thank you very much for having me. And it was a pleasure chatting with you about the PSMA PET.
Transcript is AI-generated and edited for clarity and readability.