Imaging in Prostate Cancer: An Update on a Rapidly Changing Space

An accurate assessment of the extent of disease is critical to the care of patients with cancer, across the natural history of disease including initial evaluation, following local treatment, and assessing response to systemic therapy. Thus, improvements in radiographic imaging may revolutionize the way we diagnose disease and the treatments we can offer.
Written by: Christopher J.D. Wallis, MD, PhD, & Zachary Klaassen, MD, MSc
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The Rapidly Evolving Role of PSMA In Prostate Cancer Diagnostics And Therapeutics

Prostate-specific membrane antigen (PSMA) is a type II transmembrane glycoprotein which functions as a zinc metalloenzyme and is found on prostatic epithelium. In normal prostate tissue, PSMA expression and localization focuses on the cytoplasm and apical side of the epithelium surrounding prostatic ducts. However, during prostate carcinogenesis, PSMA is transferred to the luminal surface of the ducts. 

Written by: Christopher J.D. Wallis, MD PhD and Zachary Klaassen, MD MSc
References: 1. Heindel W, Gubitz R, Vieth V, Weckesser M, Schober O, Schafers M. The diagnostic imaging of bone metastases. Dtsch Arztebl Int. 2014;111(44):741-747.
2. Yang HL, Liu T, Wang XM, Xu Y, Deng SM. Diagnosis of bone metastases: a meta-analysis comparing (1)(8)FDG PET, CT, MRI and bone scintigraphy. Eur Radiol. 2011;21(12):2604-2617.
3. Network NCC. NCCN Clinical Practice Guideslines in Oncology: Prostate Cancer - Version 1.2019. 2019.
4. Li R, Ravizzini GC, Gorin MA, et al. The use of PET/CT in prostate cancer. Prostate cancer and prostatic diseases. 2018;21(1):4-21.
5. Wondergem M, van der Zant FM, van der Ploeg T, Knol RJ. A literature review of 18F-fluoride PET/CT and 18F-choline or 11C-choline PET/CT for detection of bone metastases in patients with prostate cancer. Nucl Med Commun. 2013;34(10):935-945.
6. Nanni C, Zanoni L, Pultrone C, et al. (18)F-FACBC (anti1-amino-3-(18)F-fluorocyclobutane-1-carboxylic acid) versus (11)C-choline PET/CT in prostate cancer relapse: results of a prospective trial. Eur J Nucl Med Mol Imaging. 2016;43(9):1601-1610.
7. Calais J, Ceci F, Eiber M, et al. (18)F-fluciclovine PET-CT and (68)Ga-PSMA-11 PET-CT in patients with early biochemical recurrence after prostatectomy: a prospective, single-centre, single-arm, comparative imaging trial. The lancet oncology. 2019;20(9):1286-1294.
8. Zippel C, Ronski SC, Bohnet-Joschko S, Giesel FL, Kopka K. Current Status of PSMA-Radiotracers for Prostate Cancer: Data Analysis of Prospective Trials Listed on ClinicalTrials.gov. Pharmaceuticals (Basel). 2020;13(1).
9. Eiber M, Weirich G, Holzapfel K, et al. Simultaneous (68)Ga-PSMA HBED-CC PET/MRI Improves the Localization of Primary Prostate Cancer. European urology. 2016;70(5):829-836.
10. Hofman MS, Lawrentschuk N, Francis RJ, et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet. 2020;395(10231):1208-1216.
11. Morris MJ, Rowe SP, Gorin MA, et al. Diagnostic Performance of (18)F-DCFPyL-PET/CT in Men with Biochemically Recurrent Prostate Cancer: Results from the CONDOR Phase 3, Multicenter Study. Clinical cancer research : an official journal of the American Association for Cancer Research. 2021.
12. Pienta KJ, Gorin MA, Rowe SP, et al. A Phase 2/3 Prospective Multicenter Study of the Diagnostic Accuracy of Prostate-Specific Membrane Antigen PET/CT with (18)F-DCFPyL in Prostate Cancer Patients (OSPREY). The Journal of urology. 2021:101097JU0000000000001698.
13. Sartor O. Isotope Therapy for Castrate-Resistant Prostate Cancer: Unique Sequencing and Combinations. Cancer J. 2016;22(5):342-346.
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19. Sadaghiania M., Sheikhbahaeia S., Werner R., et al., A Systematic Review and Meta-analysis of the Effectiveness and Toxicities of Lutetium-177–labeled Prostate-specific Membrane Antigen–targeted Radioligand Therapy in Metastatic Castration-Resistant Prostate Cancer. European Urology, 2021.
20. Hofman MS, Emmett L, Sandhu S, et al. [(177)Lu]Lu-PSMA-617 versus cabazitaxel in patients with metastatic castration-resistant prostate cancer (TheraP): a randomised, open-label, phase 2 trial. Lancet. 2021;397(10276):797-804.
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