How to cite: Rowe SP. “Radiopharmaceuticals in Advanced Prostate Cancer Management.” October, 2025. Accessed Oct 2026. https://grandroundsinurology.com/radiopharmaceuticals-in-advanced-prostate-cancer-management/
Summary
Steven P. Rowe, MD, PhD, Professor of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, reviews how radiopharmaceuticals contribute to the management of advanced prostate cancer. He explains that traditional bone scans and cross-sectional imaging often fail to show the full burden of disease. Tumor-targeted diagnostic agents delivered as radiopharmaceuticals can detect metastatic lesions that remain occult on standard studies.
Dr. Rowe presents imaging examples that compare conventional scans with targeted agents, illustrating how tumor-targeted radiotracers can reveal additional lesions not indicated on earlier bone scans. He describes cases across a spectrum of metastatic volume, noting that more sensitive imaging alters how clinicians judge progression-free and metastasis-free survival. Patients once thought to have oligometastatic disease often have more extensive involvement when evaluated with targeted tracers.
He discusses therapeutic radiopharmaceuticals that deliver radiation directly to cancer cells. He comments on patients who receive lutetium-based agents and then experience progression, and whether prior local radiation influences these outcomes. Dr. Rowe notes that many such patients already have surgery or radiation before systemic radiopharmaceutical therapy, but available reports rarely stratify outcomes by prior local treatment.
Dr. Rowe emphasizes that response assessment is challenging, as some patients treated with radiopharmaceuticals have low or unreliable prostate-specific antigen (PSA) values. This means clinicians must rely on serial imaging and clinical review, rather than laboratory trends alone. Emerging efforts to track total tumor burden on imaging may be a potential response metric. Dr. Rowe concludes by reinforcing that although radiopharmaceuticals require close collaboration between nuclear medicine specialists and oncologists in order to be safely integrated, they ultimately expand options for imaging and therapy in advanced prostate cancer.
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ABOUT THE AUTHOR
Steven P. Rowe, MD, PhD, is an Professor of Radiology at University of Texas Southwestern Medical Center, Dallas, Texas. He clinically practices both diagnostic radiology and nuclear medicine, and his research work focuses on applications of novel molecular imaging agents for positron emission tomography (PET) and single-photon emission computed tomography (SPECT). He is particularly interested in the use of prostate-specific membrane antigen (PSMA)-targeted PET agents in prostate cancer and renal cell carcinoma, as well as the clinical utilization of 99mTc-sestamibi SPECT for non-invasive characterization of renal masses. He and his colleagues recently developed and validated a structured reporting system for delineating and codifying findings on PSMA PET known as PSMA Reporting and Data System (PSMA-RADS).
