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Radiomics and theranostics with molecular and metabolic probes in prostate cancer: toward a personalized approach
Luca Filippi1, Luca Urso2, Francesco Bianconi3
1Nuclear Medicine Unit, Santa Maria Goretti Hospital, via Canova, Latina, Italy.
Introduction:
In the last decade, two new radionuclide-based therapies, 223Radichloride and radioligand therapy (RLT) targeting prostate-specific membrane antigen (PSMA), have been approved by the regulatory authorities for the management of castrate-resistant prostate cancer (PCa).
Areas Covered:
The basic principles of PCa molecular imaging are illustrated, with a particular attention to the combined use of diagnosis and therapy in a unique approach (the so-called theranostics) for response prediction and assessment in patients submitted to 223Radichloride or PSMA targeted therapies. In this perspective, the potential of radiomics, an emerging discipline based on the extraction of quantitative features from medical images, is covered.
Expert Opinion:
Theranostic metabolic and molecular probes have been successfully applied to predict and monitor response to radionuclide-based therapies. In particular, both 99mTc-MDP and 18F-NaF resulted useful tools for personalized dosimetry and prognostic stratification before 223Ra-therapy, while PSMA-ligands, alone or in combination with 18F-FDG, provided valuable information to select patients who are more likely to benefit from RLT and getting information on PCa grade of differentiation and aggressiveness. In spite of its high potential, PET-radiomics for PCa is still at an embryonic phase and needs further validation.
Insights
Two new radionuclide therapies, Radium-223 dichloride and prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT), are approved for castrate-resistant prostate cancer. Molecular imaging and radiomics aid in predicting and assessing treatment response for these advanced prostate cancer therapies.
Area of Science:
- Nuclear Medicine
- Oncology
- Radiology
Background:
- Two novel radionuclide therapies, Radium-223 dichloride and PSMA-targeted radioligand therapy (RLT), have gained regulatory approval for managing castrate-resistant prostate cancer (PCa).
- Theranostics, combining diagnosis and therapy, is crucial for predicting and assessing treatment response in PCa patients undergoing these therapies.
Purpose of the Study:
- To illustrate the principles of PCa molecular imaging, focusing on theranostics.
- To explore the potential of radiomics in conjunction with radionuclide therapies for PCa management.
- To review the application of theranostic probes in predicting and monitoring response to Radium-223 and PSMA-targeted therapies.
Main Methods:
- Review of molecular imaging techniques for prostate cancer.
- Application of theranostic probes (e.g., 99mTc-MDP, 18F-NaF, PSMA-ligands, 18F-FDG) for treatment prediction and monitoring.
- Exploration of radiomics for quantitative feature extraction from medical images.
Main Results:
- 99mTc-MDP and 18F-NaF are valuable for dosimetry and prognostic stratification before Radium-223 therapy.
- PSMA-ligands, with or without 18F-FDG, help select patients for RLT and assess PCa aggressiveness.
- PET-radiomics shows promise but requires further validation in PCa.
Conclusions:
- Theranostic probes effectively predict and monitor response to radionuclide-based therapies in PCa.
- Radiomics holds significant potential for enhancing PCa theranostics, though it is in its early stages.
- Personalized dosimetry and prognostic stratification are key components of successful radionuclide therapy for prostate cancer.
