Advances and Controversies in Theranostic Approaches to Prostate Cancer

Eric M. Rohren, MD, PhD, analyzes how theranostics—combining therapeutic and diagnostic processes—are reshaping prostate cancer management. For example, prostate-specific membrane antigen (PSMA), used as a biomarker for both imaging and targeted therapy in PSMA-targeted PET scans, offers precise tumor localization, significantly enhancing diagnostic accuracy. PSMA-targeted radiopharmaceuticals such as 68Ga-PSMA-11 for PET imaging and 177Lu-PSMA-617 for therapy have been shown to improve detection rates and treatment outcomes, particularly in metastatic and castration-resistant prostate cancer.

Despite these advancements, Dr. Rohren acknowledges the challenges in theranostic approaches. The variability in PSMA expression among patients can impact the effectiveness of both imaging and therapy. Additionally, he discusses the potential side effects and toxicity associated with radioligand therapy, emphasizing the need for careful patient selection and monitoring.

Dr. Rohren also explores the ethical and regulatory considerations in the adoption of theranostics. He highlights the need for standardized protocols and guidelines to ensure consistent application and patient safety.

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