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Revolutionizing prostate cancer treatment: PSMA-targeted therapy in modern therapeutics
A Ricaurte-Fajardo1, V Marulanda-Corzo2, S Ruder3
1Department of Radiology, Division of Molecular Imaging and Therapeutics, Weill Cornell Medicine, New York, United States; Department of Neurosciences, Division of Neurology, Pontificia Universidad Javeriana, Bogotá, Colombia.
Abstract:
Prostate-specific membrane antigen (PSMA)-targeted radionuclide therapy has reshaped the treatment landscape for metastatic castration-resistant prostate cancer (mCRPC), offering new therapeutic possibilities beyond conventional approaches. Among the most promising strategies is lutetium-177 PSMA-617, which has shown significant benefits in overall survival and durable PSA responses, as demonstrated in several clinical trials. At the same time, the development of novel radionuclides such as actinium-225 has opened the door to more potent treatments capable of overcoming prior resistance, particularly in patients previously exposed to beta emitters. The use of PSMA PET imaging and the identification of predictive biomarkers have helped refine patient selection, contributing to a more personalized approach. Comparative studies with agents like cabazitaxel have further supported the safety and effectiveness of this strategy. This article provides a critical overview of clinical advances in PSMA-targeted radionuclide therapy, examines emerging combination treatments, reviews the development of alpha-emitting agents, and highlights the role of personalized dosimetry in clinical practice, underlining the growing importance of this therapeutic modality across different stages of prostate cancer.
Insights
Prostate-specific membrane antigen (PSMA)-targeted radionuclide therapy, including lutetium-177 PSMA-617, offers new hope for metastatic castration-resistant prostate cancer (mCRPC). Novel agents and personalized approaches are advancing treatment efficacy and patient selection.
Area of Science:
- Oncology
- Nuclear Medicine
- Radiopharmaceutical Therapy
Background:
- Metastatic castration-resistant prostate cancer (mCRPC) presents significant treatment challenges.
- Prostate-specific membrane antigen (PSMA)-targeted therapies have emerged as a promising treatment modality.
- Conventional treatments have limitations, necessitating novel therapeutic strategies.
Purpose of the Study:
- To provide a critical overview of clinical advances in PSMA-targeted radionuclide therapy for prostate cancer.
- To examine emerging combination treatments and novel radionuclide development.
- To highlight the role of personalized dosimetry and predictive biomarkers in patient selection.
Main Methods:
- Review of clinical trials and comparative studies involving PSMA-targeted agents.
- Analysis of data on lutetium-177 PSMA-617 and actinium-225 therapies.
- Evaluation of PSMA PET imaging and biomarker identification for patient selection.
Main Results:
- Lutetium-177 PSMA-617 demonstrates significant benefits in overall survival and PSA responses.
- Novel radionuclides like actinium-225 show potential for overcoming treatment resistance.
- PSMA PET imaging and biomarkers improve patient selection for personalized therapy.
Conclusions:
- PSMA-targeted radionuclide therapy is reshaping mCRPC treatment paradigms.
- Advancements in alpha-emitting agents and combination therapies offer expanded treatment options.
- Personalized dosimetry and patient selection are crucial for optimizing outcomes in prostate cancer management.
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