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

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 new Diagnostic Imaging podcast.

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).

(Editor’s note: For related content, see “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?” and “SNMMI: What a New Meta-Analysis Reveals About Radiotracers for PET/CT Detection of PCa.”)

For more insights from Dr. Calais and Dr. Flavell, listen below or subscribe on your favorite podcast platform.