Optimizing Prostate Cancer Management: Leveraging PSMA Imaging to Enhance Treatment Strategies
Jason Efstathiou, MD, PhD; Brandon Mancini, MD, MBA, FACRO; Comron Hassanzadeh, MD, MPH; and Bridget Koontz, MD, FASTRO, discuss the evolving role of PSMA PET imaging in prostate cancer, examining its impact on diagnosis, disease staging, treatment decisions, and posttreatment assessment. They also review key clinical trial data, current guideline recommendations, and real-world applications of PSMA PET imaging in practice.
EP. 1: The Evolving Role of PSMA PET in Prostate Cancer Imaging and Management
Panelists discuss how prospective randomized data, notably from Hofman et al (Lancet, 2020), demonstrate that PSMA PET-CT exhibits superior diagnostic accuracy compared with conventional imaging in detecting pelvic nodal and distant metastases in patients with high-risk prostate cancer. Conventional imaging techniques, such as CT and bone scans, often have lower sensitivity and specificity, potentially missing smaller or early metastatic lesions. In contrast, PSMA PET-CT offers enhanced sensitivity and specificity, leading to more precise staging and management decisions.
EP. 2: PSMA PET Imaging Agents: Image Quality and Diagnostic Performance
Panelists discuss how PSMA PET imaging utilizes various tracers, each with distinct properties influencing image quality and diagnostic accuracy. Fluciclovine F18 (Axumin) is primarily used for detecting recurrent prostate cancer, offering moderate sensitivity but lower specificity compared with PSMA-targeted agents. Gallium Ga-68 gozetotide (Illuccix) provides high sensitivity and specificity for prostate cancer lesions; however, its shorter half-life and limited availability may restrict widespread use. Piflufolastat F18 (Pylarify) combines the benefits of F18’s longer half-life with high image resolution, enhancing detection accuracy. Similarly, flotufolastat F18 (Posluma) leverages F18’s favorable imaging characteristics, offering high-quality images and reliable lesion detection.
