Molecular Imaging in Primary Staging of Prostate Cancer Patients: Current Aspects and Future Trends

Abstract

Accurate primary staging is the cornerstone in all malignancies. Different morphological imaging modalities are employed in the evaluation of prostate cancer (PCa). Regardless of all developments in imaging, invasive histopathologic evaluation is still the standard method for the detection and staging of the primary PCa. Magnetic resonance imaging (MRI) and computed tomography (CT) play crucial roles; however, functional imaging provides additional valuable information, and it is gaining ever-growing acceptance in the management of PCa. Targeted imaging with different radiotracers has remarkably evolved in the past two decades. [111In]In-capromab pendetide scintigraphy was a new approach in the management of PCa. Afterwards, positron emission tomography (PET) tracers such as [11C/18F]choline and [11C]acetate were developed. Nevertheless, none found a role in the primary staging. By introduction of the highly sensitive small molecule prostate-specific membrane antigen (PSMA) PET/CT, as well as recent developments in MRI and hybrid PET/MRI systems, non-invasive staging of PCa is being contemplated. Several studies investigated the role of these sophisticated modalities in the primary staging of PCa, showing promising results. Here, we recapitulate the role of targeted functional imaging. We briefly mention the most popular radiotracers, their diagnostic accuracy in the primary staging of PCa, and impact on patient management.

Composite risk stratification models optimise the value of imaging in prostate cancer staging

“…The detection of distant metastases in prostate cancer (PCa) staging impacts upon prognosis and management options. CT scans and isotope bone scintigraphy (BS) remain the most widely used primary staging investigations, although PSMA PET is increasingly being used 1,2 . The UK National Institute for Health and Care Excellence (NICE) guideline update in 2021 recommended switching from a three‐tier system of risk stratification to the five‐tiered Cambridge Prognostic Groups (CPG) 3 .…”

ImmunoPET: Antibody-Based PET Imaging in Solid Tumors

“…Prostate cancer cells have been targeted with different Abs and Ab fragments; however, few have been investigated in human studies. Mainly because PSMA inhibitors, showing favorable theranostic values (208,209), have cast a shadow on other targets in prostate cancer. However, immunoPET may further help evaluate the aggressive variants (231,232) or androgen receptor status or guide androgen receptor deprivation therapy (71).…”

“…Ongoing studies are striving to improve imaging in prostate cancer. The prostate-specific membrane antigen (PSMA) is known as a suitable target for prostate cancer imaging and therapy ( 208 , 209 ). Agents targeting PSMA are classified into three groups: Abs, aptamers, and PSMA inhibitors ( 210 ).…”

68Ga-PSMA-11 PET/CT Features Extracted from Different Radiomic Zones Predict Response to Androgen Deprivation Therapy in Patients with Advanced Prostate Cancer

“…68 Ga-labeled prostate-specific membrane antigen (PSMA)-targeted PET has recently emerged as a promising imaging modality for lesion detection [3,4] and monitoring of response to androgen deprivation therapy (ADT) in patients with metastatic PCa [5,6]. There is also evidence that the percentage variations of 68 Ga-PSMA-11 PET/CT imaging parameters measured before and after three months of ADT are clinically useful in evaluating treatment response [7][8][9].…”