Radiologic Perspective on Integration of Molecular Imaging and Treatment

How to cite: Iagaru AH. Radiologic Perspective on Integration of Molecular Imaging and Treatment. Grand Rounds in Urology. September 15, 2025. Accessed Jan 2026. https://grandroundsinurology.com/radiologic-perspective-on-integration-of-molecular-imaging-and-treatment/

Summary

Andrei H. Iagaru, MD, FACNM, Professor of Radiology, Stanford University, Stanford, California, offers insights into the integration of molecular imaging and therapy for prostate cancer. He emphasizes two key molecular targets: prostate-specific membrane antigen (PSMA) and gastrin-releasing peptide receptor (GRPR). While PSMA imaging and therapy are well-established, GRPR offers a complementary distribution profile that may reduce toxicity and broaden its applicability. He highlights how the differing biodistribution of these tracers influences treatment decisions, particularly in selecting patients for lutetium-based therapies.

Clinical evidence from phase 3 trials, such as VISION and PSMAfore, has demonstrated the effectiveness of lutetium PSMA-617 in treating advanced prostate cancer. Dr. Iagaru explains that molecular imaging not only identifies eligible patients but also monitors treatment response, as sequential positron emission tomography (PET) and single-photon emission computed tomography (SPECT) scans can guide the continuation, modification, or cessation of therapy.

He discusses early GRPR-targeted therapy data, noting encouraging preclinical results and initial patient studies, with tracers showing effective lesion uptake and manageable safety profiles. Importantly, combining GRPR radioligands with radiosensitizers may further enhance therapeutic outcomes. Dr. Iagaru points to the role of molecular imaging across the disease spectrum, from biochemical recurrence to high-risk localized disease to even earlier settings where prostate cancer is suspected despite inconclusive biopsies. In these contexts, PSMA and GRPR imaging may refine biopsy targeting and guide focal therapy.

Dr. Iagaru asserts that expanding the molecular imaging toolkit, integrating multiple tracers, and advancing theranostics could improve the personalization of prostate cancer management. He stresses the long-term goal of shifting effective imaging-guided therapies into earlier disease stages, potentially transforming outcomes.

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.