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There are several ongoing clinical trials looking at the use of alpha-emitting, prostate-specific membrane antigen (PSMA)-targeting therapy for patients with prostate cancer (PCa), according to Jeremie Calais, M.D., Ph.D. During a 

, Dr. Calais suggested the potential of this modality’s efficacy and reduced side effects could eventually lead to a significant role in this patient population.

“Maybe in 10 years, I think Pluvicto will be replaced by alpha-emitting agents targeting PSMA. That may be something that I foresee,” posited Dr. Calais, the director of the clinical research program with the Ahmanson Translational Theranostics Division at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA).

While cautioning that the research is in the “very early days on alpha emitters,” Robert Flavell, M.D., Ph.D., said preliminary data has shown encouraging efficacy and noted other potential attributes.

“The side effect profile is a little different with the alpha emitters. They seem to have a much more pronounced xerostomia or a dry mouth, but perhaps less toxicity in other areas like the bone marrow. So we'll see how that all plays out. Another potential advantage for alpha emitters is relatively simplified radiation handling because you're typically giving much lower administered activities, and they have lower gamma fractions, so the patients are emitting a lot less radiation to the environment and to family members,” pointed out Dr. Flavell, the chief of molecular imaging and the Therapeutics Clinical Section in the Department of Radiology and Biomedical Imaging at the University of California, San Francisco (UCSF).

(Editor’s note: For related content, see “

The Reading Room Podcast: Emerging Trends with Theranostics in Prostate Cancer, Part 1

PSMA PET/CT Facilitates Better Long-Term Survival Rates After Salvage Radiotherapy for Recurrent PCa

SNMMI: Can Multimodal Monitoring Bolster Outcomes with Pluvicto in Treating mCRPC?

For more insights from Dr. Calais and Dr. Flavell, listen below or 

In the second of a two-part podcast episode, Jeremie Calais, M.D., and Robert Flavell, M.D., discuss current and emerging alpha-emitting therapies, possible roles for artificial intelligence (AI), and what the future may hold for theranostic applications in patients with prostate cancer.

The Reading Room Podcast: Emerging Trends with Theranostics in Prostate Cancer, Part 2

More and more urologists and medical oncologists are incorporating findings from prostate-specific membrane antigen positron emission tomography (PSMA PET) into restaging decisions for patients being treated for prostate cancer (PCa), noted Jeremie Calais, M.D., Ph.D., during a 

Dr. Calais said PSMA PET agents help provide rapid and significant insight into the impact of treatment on prostate tumor volume changes.

“(It provides) major information you can monitor for the appearance of new lesions expressing PSMA or not, with the CT information, and combining that with PSA (prostate-specific antigen) and ctDNA (circulating tumor DNA) can really give you refined tumor response assessment after, you know, two cycles. I think everybody should get at least two cycles and then see if you want to continue or not, and maybe you can expect to have to change your management based on that,” asserted Dr. Calais, the director of the theranostics program with the Ahmanson Translational Theranostics Division at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA).

Robert Flavell, M.D., Ph.D., added that single-photon emission computed tomography (SPECT) offers significant utility for evaluating the effectiveness of lutetium Lu 177 vipivotide tetraxetan (Pluvicto), particularly among patients who have low PSA secretion.

“One thing to remember with the lutetium PSMA therapy is that you can use the radiation from the therapy to generate an image. It does, in fact, admit a lower fraction of gammas. So if you perform SPECT imaging with every cycle, you essentially get a free PET scan every cycle without administrating additional radiopharmaceutical. We've definitely found this is pretty useful for following response to therapy,” pointed out Dr. Flavell, the chief of molecular imaging and the therapeutics clinical section in the Department of Radiology and Biomedical Imaging at the University of California, San Francisco (UCSF).

SNMMI: 18F-Piflufolastat PSMA PET/CT Offers High PPV for Local PCa Recurrence Regardless of PSA Level

SNMMI: Can 18F-Fluciclovine PET/CT Bolster detection of PCa Recurrence in the Prostate Bed?

SNMMI: What a New Meta-Analysis Reveals About Radiotracers for PET/CT Detection of PCa

In the first of a two-part podcast episode, Jeremie Calais, M.D., and Robert Flavell, M.D., discuss recent advances with PSMA-targeted radiotracers in the treatment of metastatic castration-resistant prostate cancer (mCRPC), and the role of imaging criteria in monitoring patients treated with PSMA-targeted radionuclide therapy.

For Satoshi Minoshima, M.D., Ph.D., the approval of new anti-amyloid treatments and emerging research on the use of blood-based biomarkers were key developments that fueled the 

recently updated appropriate use criteria (AUC)

 for brain positron emission tomography (PET) in patients with mild cognitive impairment (MCI)

, Dr. Minoshima noted that amyloid PET wasn’t recommended 10 years ago for patients who had an established diagnosis of Alzheimer’s disease. However, with the approvals of the anti-amyloid therapies lecanemab (Leqembi, Eisai/Biogen) and donanemab (Kisunia, Eli Lilly), Dr. Minoshima said amyoid PET enables clinicians to confirm target expression within the brain in these patients prior to treatment.

Additionally, in light of emerging evidence on the use of blood-based biomarkers, Dr. Minoshima notes the utility of amyloid PET imaging if cerebrospinal fluid (CSF) or other fluid biomarker results are uncertain or incongruent with the clinical diagnosis.

“I think maybe that’s a great opportunity to do amyloid PET imaging,” posited Dr. Minoshima, a past president and current chair of value initiative at the Society of Nuclear Medicine and Molecular Imaging (SNMMI).

The updated AUC also incorporated the use of tau PET imaging, which could enhance assessment of neuronal injury and possibly assist in differentiating Alzheimer’s disease and other neurodegenerative conditions, according to Dr. Minoshima.

“This clinical distinction between progressive supranuclear palsy (PSP) and Alzheimer’s disease is actually quite difficult, so hopefully the availability of tau pet in the future is going to give us a better differential diagnosis so combining (tau PET) with amyloid PET, we can guide the patient to the right treatment,” noted Dr. Minoshima, the Anne G. Osborn Chair and professor in the Department of Radiology and Imaging Sciences at the University of Utah.

In the podcast, James Williams, the chief executive officer for Siemens Healthcare Molecular Imaging, also noted that the availability of low-cost, easily to perform blood tests in the future may lead to a broader population of patients being tested for neurodegenerative diseases due to family history or genetic predisposition.

“In those cases, I think the imaging gets even more critical because certainly you wouldn't want to … subject someone to the therapy until you're very sure what's going to happen, but they're going to be a different patient population too. (These are) not the images we've seen in the clinical trials or for a large part of the research up to (now),” added Williams.

SNMMI Issues New Appropriate Use Criteria for Amyloid PET and Tau PET Imaging

A Closer Look at the New Appropriate Use Criteria for Brain PET: An Interview with Phillip Kuo, MD, Part 1

A Closer Look at the New Appropriate Use Criteria for Brain PET: An Interview with Phillip Kuo, Part 2

For more insights from Dr. Minoshima and Dr. Williams, listen below or 

In a new podcast, Satoshi Minoshima, M.D., Ph.D., and James Williams, Ph.D., share their insights on the recently updated appropriate use criteria for amyloid PET and tau PET in patients with mild cognitive impairment.

The Reading Room Podcast: Current Perspectives on the Updated Appropriate Use Criteria for Brain PET

Pluvicto in combination with the standard of care led to a 28 percent reduction in the risk of radiographic progression or death in patients with metastatic hormone-sensitive prostate cancer (mHSPC), according to results from the phase III PSMAddition trial presented at the European Society for Medical Oncology (ESMO) conference.

New PSMA PET Research Shows Merits of Pluvicto in Metastatic Hormone-Sensitive Prostate Cancer (mHSPC)

In the 160-patient study comparing 18F-PSMA 1007 PET/CT and 18F-NaF PET/CT, the use of 18F-PSMA PET/CT led to 38 patients being restaged as having more advanced prostate cancer.

Study: PSMA PET/CT Leads to Metastatic Staging Changes in 25 Percent of Patients with Newly Diagnosed High-Risk PCa

The combination of digital breast tomosynthesis (DBT) and molecular breast imaging (MBI) offered more than double the detection of invasive breast cancer with DBT in the first year of screening, according to a prospective study of nearly 3,000 women with dense breasts.

Can Supplemental Molecular Breast Imaging Enhance Breast Cancer Detection in Women with Dense Breasts?

PSMA PET offered 18 percent higher accuracy for detecting biochemical recurrence of PCa in contrast to mpMRI, according to findings from a 67-study meta-analysis.

Meta-Analysis Shows Benefits of PSMA PET in Detecting Recurrence and Metastasis with PCa

Issued by multiple societies, including the Society of Nuclear Medicine and Molecular Imaging (SNMMI), the new guidelines for utilizing 18F-flurpiridaz-PET myocardial perfusion imaging (MPI) offer insights on proper patient selection, appropriate protocols and salient keys for image interpretation.

Nine Takeaways from New Guidelines on PET Myocardial Perfusion Imaging

’s Weekly Scan, which offers an opportunity to catch up on the most well-viewed radiology content of the past week.

new meta-analysis of the PI-RADS v2.1 criteria

 showed 96 percent and 88 percent sensitivity rates for PI-RADS category 

 4 assessments respectively, researchers noted a high risk of bias in 29 percent of the reviewed studies.

New research involving over 82,000 women suggests that 

concordance between radiologist interpretation and AI assessment of screening mammography

 may be associated with significantly higher risks of future breast cancer than unassisted radiologist evaluation alone.

In the second part of a recent interview with 

Emmanuel S. Antonarakis, M.D. discusses PSMA PET agents in current trials and cell surface proteins 

that may offer targeting utility in prostate cancer imaging beyond PSMA.

combination of key radiomic features and deep learning AI

 may significantly improve chest computed tomography (CT) differentiation of invasive adenocarcinoma (IAC), atypical adenomatous hyperplasia and adenocarcinoma in situ (AAH + AIS) and inflammatory nodules (IN).

Through enhanced data interoperability and access to patient histories, the 

newly launched cloud-based platform InteleHeart

 may facilitate better communication and workflow efficiencies for radiologists and cardiologists.

Morris Panner shared his thoughts on InteleHeart in a recent interview with 

Diagnostic Imaging's Weekly Scan is your chance to catch up on the latest radiology content, from new research and device news to the latest interviews with leading KOLs..

Diagnostic Imaging’s Weekly Scan: October 12 — October 18

Catch up on the top radiology content of the past week.

Diagnostic Imaging's Weekly Scan: October 12 — October 18

Discussing investigational prostate-specific membrane antigen (PSMA) positron emission tomography (PET) agents being evaluated in current trials for prostate cancer (PCa) imaging, Emmanuel S. Antonarakis, M.D., said copper CU-64 PSMA I&T, currently the subject of two separate ongoing studies, may offer potential advantages to the currently approved agents Ga-68 PSMA-11 and piflufolastat F18.

“(CU-64 PSMA I&T has) a higher tumor-specific uptake, which means that you could theoretically get improved lesion contrast with the potential to detect smaller lesions. Because of the longer half life, there's an option to do the imaging 24 hours or 48 hours after the injection of the agent, and that may concentrate better in the tumor as opposed to the adjacent normal organs,” noted Dr. Antonarakis, a Clark Endowed Professor of Medicine, director of genitourinary oncology and associate director for translational research with the Masonic Cancer Center at the University of Minnesota.

(Editor’s note: For additional insights on prostate cancer imaging, click 

In addition to PSMA, other cell surface targeting approaches may offer potential utility in prostate cancer imaging, according to Dr. Antonarakis.

“There are other cell surface targets that we think are highly expressed in prostate cancer that could also one day become targets for imaging,” suggested Dr. Antonarakis. “For example, there's a protein called STEAP1 (Six-transmembrane epithelial antigen of prostate 1). There's a protein called B7-H3 and there's a protein called TROP2, and these are examples of cell surface proteins.”

Current Perspectives on Prostate Cancer and Emerging Theranostic Agents, Part 1

For more insights from Dr. Antonarakis, watch the video below.

In the second part of a recent interview, Emmanuel S. Antonarakis, M.D. discusses PSMA PET agents in current trials and cell surface proteins that may offer targeting utility in prostate cancer imaging beyond PSMA.

Current Perspectives on Prostate Cancer and Emerging Theranostic Agents, Part 2

Journal of the American College of Radiology

preoperative breast MRI revealed additional suspicious lesions in over 50 percent of women slated to undergo surgery for newly diagnosed breast cancer

 and was associated with an 18 percent higher rate of mastectomy.

In a prospective study published earlier this week in 

comparable 10-year overall survival rates

 for people who had computed tomography (CT) surveillance (94.7 percent) and those who had surgery for ground-glass nodules (97.6 percent).

, Emmanuel S. Antonarakis, MD discussed contributing factors to the recent American Cancer Society report about rising prostate cancer incidence and 

offered insights about the potential role of the emerging radioligand agent 177Lu-PSMA-I&T for patients with mCRPC

, Manisha Bahl, MD, discussed new research, recently presented at the European Society of Breast Imaging, which showed 

significant associations between AI detection and the histologic grade and lymph node status of breast cancer

Earlier this week, the Society of Abdominal Radiology issued 

new consensus recommendations on the use of abdominal photon-counting CT

 in adults. Based on survey findings and subsequent voting from radiologists at nine facilities, researchers offered 20 recommendations on key protocol features.

Diagnostic Imaging’s Weekly Scan: October 5 — October 11

Catch up on the top radiology content of the past week.



Diagnostic Imaging's Weekly Scan: October 5 — October 11

While a recent report from the American Cancer Society noted a 3 percent annual increase in prostate cancer (PCa) incidence and a 4.6-4.8 percent annual increase in advanced PCa diagnoses from 2014 to 2021, Emmanuel S. Antonarakis, M.D. said it is important to keep these statistics in perspective.

In addition to a downturn in PSA screening after an adverse recommendation from the U.S. Preventive Services Task Force (USPSTF) in 2012 and the aging of the population, there has been a “stage migration” with the advent of prostate-specific membrane antigen positron emission tomography (PSMA PET) contributing to the rise of advanced PCa detection, noted Dr. Antonarakis in a recent interview with 

“The reason why I am confident calling it a stage migration is that if you look at the mortality from prostate cancer during that same time frame, it has not increased. It's been relatively stable. So despite an increasing incidence and despite an increasing advanced disease prevalence, we are not seeing an increase in mortality. … The advent of these PSMA PET scans and other molecular imaging, while they increase the detection of disease, they will also artificially increase the number of advanced patients that are diagnosed,” explained Dr. Antonarakis, a Clark Endowed Professor of Medicine and director of genitourinary oncology with the Masonic Cancer Center at the University of Minnesota.

In discussing emerging theranostic approaches to treating PCa, Dr. Antonarakis noted the potential of the radioligand agent 177Lu-PSMA-I&T for patients with metastatic castration-resistant prostate cancer (mCRPC). While this modality is currently being evaluated in a phase 3 clinical trial, Dr. Antonarakis suggested that 177Lu-PSMA-I&T may emerge as a viable alternative prior to chemotherapy in this patient population.

“I would be extremely interested to see also how the overall survival looks. … We do not know if this is going to be the case, but if the overall survival is also positive, to me, that would be an advantage for a medical oncologist to select PSMA-I&T as opposed to PSMA-617, which the latter did not demonstrate an overall survival advantage in the pre chemotherapy setting. So, we shall see what the results are like,” posited Dr. Antonarakis.

In a recent interview, Emmanuel S. Antonarakis, M.D. discussed contributing factors to the recent American Cancer Society report about rising prostate cancer incidence and offered insights about the potential role of the radioligand agent 177Lu-PSMA-I&T for patients with mCRPC.

New research, published earlier this week in 

MRI-based pancreatic risk stratification model (M-PRiSM)

 offers enhanced prognostic insight into postoperative survival for patients being treated for pancreatic ductal adenocarcinoma (PDAC).

In a prospective study, recently published in the 

, researchers found that deep learning image reconstruction (DLIR) may facilitate up to a 

45 percent reduction in radiation dosing with dual-energy computed tomography (DECT)

Speaking of radiation dosing, in a recent interview with 

, Dr. Rebecca Smith-Bindman discussed a new study, published in the 

impact of cumulative radiation exposure from medical imaging upon hematologic cancer risk in children

In a new 67-study meta-analysis published in 

PSMA PET offered significantly higher accuracy in detecting biochemical recurrence (BCR), lymph node metastasis and bone metastasis

 in comparison to multiparametric MRI (mpMRI) and computed tomography (CT).

combination of digital breast tomosynthesis (DBT) and molecular breast imaging (MBI)

 offered more than double the detection of invasive breast cancer with DBT in the first year of screening, according to a prospective study of nearly 3,000 women with dense breasts.

Diagnostic Imaging's Weekly Scan is your chance to catch up on the latest radiology content, from new research and device news to the latest interviews and conference reports. 

Diagnostic Imaging's Weekly Scan: September 21 — September 27

Welcome to Diagnostic Imaging’s Weekly Scan, which offers an opportunity to catch up on the most well-viewed radiology content of the past week.

In light of emerging research suggesting an 

increased incidence of breast cancer among women under the age of 40

, Drs. Jean Seely, MD, Zeeshan Shah, MD and Amy Patel, MD, discussed what they’re seeing in practice and emphasized increased vigilance to facilitate early detection.

In a new retrospective study published earlier this week in the 

the impact of radiation exposure from medical imaging

 in a cohort of over 3.7 million children. They estimated that radiation exposure from imaging may be associated with 10.1 percent of hematologic cancers in this patient population.

, Drs. Noa Antonissen and Colin Jacobs discussed new research suggesting that a CT-based deep learning model may facilitate 

a nearly 40 percent reduction in false positives with indeterminate lung nodules

Multiple nuclear medicine societies, including the Society of Nuclear Medicine and Molecular Imaging, unveiled 

guidelines this week for PET myocardial perfusion imaging (MPI)

. Check out our takeaways from the new recommendations on appropriate protocols and keys for interpretation of PET MPI.

In a new breast ultrasound study focusing on BI-RADS category 4 and 5 mass presentations, researchers noted that the 

 had an 81 to 85 percent specificity for malignancy.

Diagnostic Imaging's Weekly Scan is your chance to catch up on the latest radiology content, from new research and device news to the latest conference reports.

Diagnostic Imaging's Weekly Scan: September 14 — September 20

 published research revealed that having PSMA PET/CT scans before salvage radiotherapy resulted 

in higher rates of survival and biomechanical recurrence-free survival at one, three and five years

neuroradiologist Tammie Benzinger discussed the utility of low-field MRI

 in facilitating appropriate triage and health equity for patients with suspected Alzheimer’s disease.

In a new digital breast tomosynthesis (DBT) study published in the 

78 percent malignancy rate when DBT images showed a combination of architectural distortion with highly suspicious m

Catch up on the latest news, research and insights in radiology with our Weekly Scan.

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