Nuclear Medicine and External Beam Radiation Therapy in Prostate Cancer: A Synergistic Approach

Area of Science:

• Oncology
• Nuclear Medicine
• Radiotherapy

Background:

• Radiopharmaceutical therapy (RPT) combined with external beam radiotherapy (EBRT) is an emerging treatment strategy for prostate cancer.
• This combination leverages EBRT for visible tumors and RPT for microscopic or systemic disease, building on historical 89Sr trials.
• Clinical and preclinical data indicate improved tumor control, pain relief, and quality of life with manageable toxicity.

Purpose of the Study:

• To review the current evidence and future directions for combined RPT and EBRT in prostate cancer treatment.
• To highlight the role of advanced imaging, particularly prostate-specific membrane antigen (PSMA) PET, in patient selection and treatment planning.
• To discuss the potential of PSMA-targeted RPT, such as 177Lu-PSMA, in improving outcomes for metastatic castration-resistant prostate cancer.

Main Methods:

• Review of clinical and preclinical evidence on combined RPT and EBRT.
• Emphasis on the role of PSMA PET imaging in disease mapping and treatment planning.
• Discussion of PSMA-targeted RPT and its application in metastatic castration-resistant prostate cancer.

Main Results:

• Combined RPT and EBRT demonstrates enhanced tumor control, pain relief, and quality of life.
• PSMA-targeted RPT, including 177Lu-PSMA, shows overall survival benefits in metastatic castration-resistant prostate cancer.
• Advanced imaging like PSMA PET is crucial for precise treatment strategies.

Conclusions:

• Combined RPT and EBRT is a promising approach for personalized prostate cancer care.
• Ongoing trials are exploring concurrent/sequential strategies and alpha-emitter radioligands to further improve survival.
• Addressing logistical challenges will facilitate the integration of combined RPT and EBRT into standard treatment paradigms.