2024

Radiopharmaceuticals in Advanced Prostate Cancer

Radiopharmaceuticals in Advanced Prostate Cancer

Posted by | Jun 2025

Steven P. Rowe, MD, PhD, delves into the transformative potential and challenges of radioligand therapy in managing advanced prostate cancer. In this 21-minute presentation, Dr. Rowe emphasizes the excitement surrounding the efficacy and tolerability of agents like lutetium PSMA-617, contrasting them with harsher cytotoxic treatments. A nuanced discussion addresses pitfalls in PSMA PET imaging, highlighting false positives and underscoring the necessity of careful interpretation.

Toxicity management and manageable side effects are discussed. Innovations in imaging biomarkers and longitudinal PSMA PET imaging are positioned as tools to refine response assessment and personalize therapy.

Given differences in training and systemic constraints, challenges in translating European advancements to US practice are acknowledged. Further, Dr. Rowe critiques limitations in AI and radiomics applications for PET scans, highlighting the inability to characterize findings accurately. Ultimately, Dr. Rowe advocates integrating PSMA PET into clinical trials and enhancing therapy stratification to maximize patient benefit.

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Can Imaging Replace Prostate Biopsy – Primary Detection, Active Surveillance and Recurrent PCa?

Can Imaging Replace Prostate Biopsy – Primary Detection, Active Surveillance and Recurrent PCa?

Posted by | Jun 2025

Veeru Kasivisvanathan, MBBS, BSc, FRCS, PhD, MSc, PGCert, reflects on the significant advancements in prostate imaging over the last decade, emphasizing the transformative role of MRI. A central question in this 15-minute presentation is whether prostate cancer can be diagnosed and managed without a biopsy. While biopsies are the current standard, they carry risks such as sepsis, patient discomfort, and financial burden.

The PROMIS study demonstrated MRI’s ability to detect all Gleason 4+3 cancers, though it also revealed MRI’s high number of false positives. Combining PSMA PET with MRI improves sensitivity to 97%, particularly for detecting clinically significant cancers, but specificity remains a challenge, raising concerns about unnecessary treatment. New scoring systems, like the P score, integrate PET avidity and PI-RADS scores to refine risk assessment and treatment decisions.

Kasivisvanathan discusses the concept of “biopsy-light” pathways, citing cohorts where patients undergo fewer biopsies, with monitoring driven by MRI and PSA changes. This approach shows promising compliance and oncological outcomes comparable to standard active surveillance but with less patient burden. Despite advancements, a fully biopsy-free pathway remains unfeasible due to limitations in MRI standardization, interpretation variability, and a lack of high-volume data.

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