Dr Sartor on PSMA PET and Radioligand Therapy in Prostate Cancer

Oliver Sartor, MD, medical oncologist, Division of Medical Oncology, Department of Oncology, Mayo Clinic, chair, Genitourinary Cancer Disease Group, director, Radiopharmaceutical Clinical Trials, Mayo Clinic Comprehensive Cancer Center, discusses the use of prostate-specific membrane antigen (PSMA) PET and radioligand therapy in patients with prostate cancer, expanding on questions regarding the inclusion of these agents in the treatment paradigm.

Within the domain of PSMA radioligand therapy, the use of PSMA PET is instrumental, serving pivotal roles in both patient selection and ongoing monitoring, Sartor begins. However, the intricacies of patient monitoring are complex and characterized by a notable scarcity of comprehensive data, which in turn fosters controversy, he states. Although the integration of PSMA SPECT alongside PSMA PET holds promise for enhancing monitoring capabilities, the quest for an optimal imaging approach remains multifaceted, Sartor explains. Factors such as scanning frequency, interpretation methodologies, and timing protocols are subjects of ongoing scrutiny and debate, he adds.

Shifting focus to patient selection, a distinct perspective, particularly prevalent in Australia, advocates for a comprehensive approach that includes the incorporation of PSMA PET and fluorodeoxyglucose PET in conjunction with conventional imaging techniques, adhering closely to FDA guidelines, Sartor continues. However, even within this framework, the quest for predictive success parameters persists as an ongoing priority, he adds. The endeavor to discern the most salient factors that predict treatment efficacy necessitates further research efforts and data analysis, Sartor elucidates.

In essence, although strides have been made in understanding the role of PSMA PET results in PSMA radioligand therapy decision-making, a robust consensus remains elusive, he expands. The prostate cancer diagnostic and treatment paradigms are marked by a continuous quest for clarity and refinement, and the need for additional evidence and empirical insights is paramount, Sartor notes. As such, ongoing research endeavors seek to elucidate the most effective methodologies and practices in both patient monitoring and selection within the realm of PSMA radioligand therapy, aiming to enhance treatment outcomes and optimize patient care, he concludes.