Jason Efstathiou, MD, DPhil, FASTRO, FACRO

Panelists discuss how PSMA PET imaging is expected to evolve, enhancing precision in prostate cancer treatment through improved detection and staging. Medical professionals anticipate broader use in therapy guidance, with future advancements addressing gaps in early detection and metastasis, improving treatment strategies.

Panelists discuss how, Copper-64 (^64Cu)–labeled PSMA-targeted PET imaging is emerging as a promising modality in prostate cancer diagnosis. The phase 2 SOLAR study (NCT05653856) demonstrated that ^64Cu-PSMA I&T PET/CT effectively detects metastatic prostate cancer, meeting primary end points related to correct localization rates. Compared with gallium-68 (^68Ga) and fluorine-18 (^18F), ^64Cu offers a half-life of approximately 12.7 hours, facilitating centralized production and distribution, which may improve accessibility

Panelists discuss how PSMA PET imaging identified a region of high tracer uptake, guiding medical professionals to implement a focal radiation boost. This approach improved treatment precision and targeting of aggressive areas, highlighting the potential for personalized, effective therapies.

Panelists discuss how PSMA PET imaging has significantly influenced prostate cancer management by enabling precise detection of metastatic lesions, thereby informing and altering treatment strategies. For instance, a study demonstrated that ^68Ga-PSMA-11 PET/CT impacted definitive radiation therapy (RT) planning in 16.5% of patients, leading to modifications in RT fields based on the imaging findings.

Panelists discuss how PSMA PET imaging is increasingly utilized to assess treatment response in prostate cancer, offering superior accuracy over PSA monitoring alone. Incorporating PSMA PET into clinical practice involves considering factors such as timing post treatment and the specific clinical scenario. For instance, studies have demonstrated that PSMA PET/CT can detect intraprostatic and metastatic lesions even at very low PSA levels during treatment monitoring.

Panelists discuss how, PSMA PET imaging significantly enhances surgical decision-making in prostate cancer by precisely identifying tumor location, extent, and metastatic spread with superior sensitivity compared to conventional imaging. This molecular targeting enables more accurate surgical planning, improved patient selection for radical prostatectomy versus targeted approaches, and better identification of lymph node involvement, ultimately allowing for personalized treatment strategies that maximize oncological outcomes while minimizing unnecessary interventions.

Panelists discuss how PSMA PET imaging plays a crucial role in detecting biochemical recurrence of prostate cancer, offering superior sensitivity and specificity compared with conventional imaging methods. In clinical practice, PSMA PET is typically ordered when there is a rise in prostate-specific antigen (PSA) levels post treatment, indicating potential recurrence. The imaging results significantly influence treatment decisions such as distinguishing between localized salvage therapy and systemic treatments. Pivotal trials have demonstrated the efficacy of various tracers.

Panelists discuss how PSMA PET imaging plays a crucial role in the initial staging of prostate cancer, offering superior accuracy over conventional methods. Medical professionals consider factors such as diagnostic performance, tracer availability, and patient-specific characteristics when selecting appropriate PSMA PET agents. The integration of PSMA PET findings into clinical practice has led to more precise treatment planning, potentially improving patient outcomes. Pivotal trials have demonstrated the efficacy of various PSMA PET tracers in detecting prostate cancer metastases.

Panelists discuss how high-quality imaging is crucial for accurately staging prostate cancer, guiding treatment decisions, and optimizing patient outcomes. Superior resolution and sensitivity of PSMA PET tracers enhance lesion detection, influencing surgical, radiation, and systemic therapy choices. Differences in tracer properties impact specificity, affecting treatment planning. Advanced imaging reduces uncertainty, improving risk stratification and therapeutic precision.

Panelists discuss how medical professionals select PSMA PET tracers based on factors such as diagnostic accuracy, tracer availability, patient-specific considerations, and logistical aspects such as half-life and production facilities. Fluorine-18 (^18F)–labeled tracers, such as ^18F-PSMA-1007, offer logistical advantages due to their longer half-life and higher image resolution, facilitating broader clinical application.

Panelists discuss how PSMA PET imaging utilizes various tracers, each with distinct properties influencing image quality and diagnostic accuracy. Fluciclovine F18 (Axumin) is primarily used for detecting recurrent prostate cancer, offering moderate sensitivity but lower specificity compared with PSMA-targeted agents. Gallium Ga 68 gozetotide (Illuccix) provides high sensitivity and specificity for prostate cancer lesions; however, its shorter half-life and limited availability may restrict widespread use. Piflufolastat F18 (Pylarify) combines the benefits of F18’s longer half-life with high image resolution, enhancing detection accuracy. Similarly, flotufolastat F18 (Posluma) leverages F18’s favorable imaging characteristics, offering high-quality images and reliable lesion detection.

Panelists discuss how prospective randomized data, notably from Hofman et al (Lancet, 2020), demonstrate that PSMA PET-CT exhibits superior diagnostic accuracy compared with conventional imaging in detecting pelvic nodal and distant metastases in patients with high-risk prostate cancer. Conventional imaging techniques, such as CT and bone scans, often have lower sensitivity and specificity, potentially missing smaller or early metastatic lesions. In contrast, PSMA PET-CT offers enhanced sensitivity and specificity, leading to more precise staging and management decisions.