Prostate-specific membrane antigen theranostics in advanced prostate cancer: an evolving option

Area of Science:

• Oncology
• Nuclear Medicine
• Radiopharmaceutical Therapy

Background:

• Advanced prostate cancer, particularly metastatic castrate-resistant prostate cancer (mCRPC), presents significant treatment challenges.
• Prostate-specific membrane antigen (PSMA) is a validated target for diagnostic and therapeutic applications in prostate cancer.

Purpose of the Study:

• To review current data on PSMA-based radioligand therapy (RLT) for advanced prostate cancer.
• To update multidisciplinary teams on the current and future applications of theranostics in prostate cancer management.

Main Methods:

• Narrative review of existing literature on PSMA as a target for RLT.
• Focus on data from small-molecule PSMA inhibitors bound to beta-emitting radioisotopes, specifically 177Lu (Lu-PSMA).

Main Results:

• RLT with PSMA is a viable therapeutic alternative for patients with mCRPC.
• Prospective phase II data demonstrate the safety and efficacy of Lu-PSMA in heavily pre-treated mCRPC patients.
• Ongoing late-phase randomized trials are evaluating Lu-PSMA, with encouraging early results.

Conclusions:

• PSMA RLT represents a promising new treatment modality for men with mCRPC.
• The theranostic approach utilizing PSMA may also benefit patients with earlier stages of prostate cancer.