EAU 2017: 4th ESO Prostate Cancer Observatory: The Imaging Specialist’s Perspective on PSMA

London, England (UroToday.com) Dr. Haberkorn delivered the much anticipated imaging specialist’s perspective on PSMA-PET/CT at this morning’s 4th ESO Prostate Cancer Observatory: Innovation and Care in the Next 12 Months session.

Dr. Haberkorn started this session by reviewing the literature showing that PSMA-PET/CT is able to detect recurrent disease at lower PSA levels when compared to 18F-choline PET/CT scan. Specifically, PSMA outperforms 18F-choline (71% vs 26%) with regards to detecting disease recurrence at PSA levels of 0.5-2.0 ng/mL.

Second, Dr. Haberkorn delineated the Heidelberg experience with PSMA radioligand treatment regimens, showing exciting bone scan images of patients with excellent, initial response. Specific agents that have showed promise include 177Lu-PSMA and 225Ac-PSMA. Indeed, Dr. Haberkorn described a patient presenting with a PSA >3,000 ng/mL and wide spread bone-metastatic disease that had complete bone and PSA response with 4 treatments of 225-Ac-PSMA radioligand. However, given the disease and PSMA expression heterogeneity, nearly all patients have relapse in bone metastatic disease typically around 6 months post-treatment.

Certainly, there are exciting times in the field of nuclear medicine and prostate cancer, specifically PSMA imaging and PSMA radioligand therapy. Dr. Haberkorn notes that future directions we should be expecting over the next 12+ months include (i) addressing the heterogeneity of PSMA expression and continue to develop new tracers with new targets, (ii) address upregulated pathways in CRPC, including bFGFR, EGFR, and MET, and (iii) explore combination therapy of PSMA radioligands with therapy targeting metabolism (ie fatty acid synthesis).

Presented by: Uwe Haberkorn, University Hospital, Heidelberg, Germany

Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto
Twitter: @zklaassen_md

at the #EAU17 -March 24-28, 2017- London, England