What Medical, Urologic, and Radiation Oncologists Want from Molecular Imaging of Prostate Cancer

Abstract

As molecular imaging better delineates the state of prostate cancer, clinical management will evolve. The currently licensed imaging modalities are limited by lack of specificity or sensitivity for the extent of cancer and for predicting outcome in response to therapy. Clinicians want molecular imaging that-by being more reliable in tailoring treatment and monitoring response for each patient-will become a key facet of precision medicine, surgery, and radiation therapy. Identifying patients who are candidates for specific or novel treatments is important, but equally important is the finding that a given patient may not be a good candidate for single-modality therapy. This article presents prostate cancer scenarios in which managing clinicians would welcome molecular imaging innovations to help with decision making. The potential role of newer techniques that may help fill this wish list is discussed.

Clinical perspectives of PSMA PET/MRI for prostate cancer

“…Detecting specific BCR sites with imaging has been a challenging for the last 10 years, even with the development of dedicated MRI. Disease detection is clinically relevant because it can guide more effective treatment planning and consequently avoid futile systemic or localized treatment approaches and their related side effects 32 .…”

“…MRI has become the method of choice for local recurrence, with a sensitivity of approximately 75%. Although MRI performs better than conventional imaging, identifying local recurrence is the least important for making changes to salvage treatment, as radiation therapy of the prostate bed is the first indicated method for BCR in patients with low PSA levels 32 .…”

Diagnostic sensitivity of Tc-99m HYNIC PSMA SPECT/CT in prostate carcinoma: A comparative analysis with Ga-68 PSMA PET/CT

“…In South Africa, it is only second to basal cell carcinoma of the skin as the commonest cancer type in men and is responsible for 13% of all cancer deaths among South African men . In the management of prostate cancer, imaging plays an important role in disease detection, initial staging, therapy response evaluation, and surveillance following initial curative radical prostatectomy or external beam radiotherapy …”

“…3 In the management of prostate cancer, imaging plays an important role in disease detection, initial staging, therapy response evaluation, and surveillance following initial curative radical prostatectomy or external beam radiotherapy. 4 Data are emerging to show the superiority of gallium-68 labeled prostate specific membrane antigen imaging with combined positron emission tomography and computed tomography (Ga-68 PSMA PET/ CT) over other molecular imaging modalities as well as morphologic imaging with computed tomography (CT) or magnetic resonance imaging (MRI). [5][6][7] Prostate specific membrane antigen (PSMA) is a trans-membrane glycoprotein that is overexpressed on prostate cancer cells.…”

PSMA PET: Transformational Change in Prostate Cancer Management?

“…Prostate-specific membrane antigen (PSMA) is not an antigen (it is a transmembrane protein), is not specific to the prostate gland (it is expressed in other normal tissues), and is not specific to prostate cancer (it is expressed in many benign conditions and cancers other than prostate cancer). Nevertheless, PSMA is highly relevant in prostate cancer theranostics in view of its marked overexpression in prostate cancer (1,2). Over the past several years, there have been major strides in the design, synthesis, and evaluation of smallmolecule radionuclides targeting PSMA for imaging and therapy (3).…”