Hossein Jadvar, MD, PhD, MPH, MBA, MSL, FACNM, FSNMMI, presented “LuPSMA: Imaging-Based Patient Eligibility Role of Tumor Heterogeneity & FDG” during the 7th Global Summit on Precision Diagnosis and Treatment of Prostate Cancer on September 21, 2023.
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How to cite: Jadvar, Hossein. “LuPSMA: Imaging-Based Patient Eligibility Role of Tumor Heterogeneity & FDG.” September 21, 2023. Accessed May 2024. https://grandroundsinurology.com/lupsma-imaging-based-patient-eligibility-role-of-tumor-heterogeneity-fdg/
LuPSMA: Imaging-Based Patient Eligibility
Role of Tumor Heterogeneity & FDG – Summary
Hossein Jadvar, MD, PhD, MPH, MBA, MSL, FACNM, FSNMMI, discusses imaging-based patient eligibility for Lutetium-177 Prostate-Specific Membrane Antigen (177Lu-PSMA) and the role of tumor heterogeneity and 18F-fluorodeoxyglucose (FDG) in treatment failure. He begins by reviewing a study on the prediction of time to hormonal-treatment failure in metastatic castration-sensitive prostate cancer with FDG positron emission tomography/computed tomography (PET/CT) and another study assessing the association of FDG PET/CT with overall survival in men with metastatic castration-resistant prostate cancer (mCRPC).
Dr. Jadvar addresses mCRPC tumor heterogeneity within and across tumors and prediction of discordance between Gallium-68-PSMA-11 therapy and FDG, citing the LuPSMA trial, the TheraP trial, and the VISION trial. He then shares data on PSMA heterogeneity in mCRPC related to circulating tumor cells (CTC), metastatic tumor burden, and response to targeted RLT.
Dr. Jadvar shares the European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM) consensus statements that PSMA PET demonstration of PSMA expression should be mandatory before treating with 177Lu-PSMA RLT. He then shares patient case studies illustrating the pros and cons of FDG PET/CT in PSMA radiopharmaceutical therapy (RPT).
Dr. Jadvar concludes by emphasizing that PSMA PET should be mandatory before PSMA RPT. He reminds practitioners to carefully consider what is optimal vs. what is required vs. what is practical.
The Global Summit on Precision Diagnosis and Treatment of Prostate Cancer is a unique multi-disciplinary forum organized to inform the key health care stakeholders about the emerging advances in clinical case and research and create a consensus-based vision for the future of precision care and educational and research strategy for its realization. The mission of the Summit is to fill the currently existing gap between the key experts of in vivo imaging, the world authorities in the in vitro fluid- and tissue-based molecular diagnostics, including genomics, and thought leaders in the development of novel observation strategies (e.g., active surveillance, or AS) and therapeutic interventions.
