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PEER-TO-PEER CLINICAL CONVERSATIONS |
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Theranostics in nmCRPC: From PSMA PET Imaging to Lutetium-177 Therapy
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Sherief Gamie, MD, PhD
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| Sherief Gamie reviews the evolution and impact of molecular targeted imaging in castration-resistant prostate cancer. He traces the progression from early ProstaScint imaging in the 1980s to today's sophisticated PSMA PET/CT, emphasizing PSMA's high specificity for prostate cancer cells.
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The Use of a Long-Axial PET Scanner for PSMA Imaging in Prostate Cancer
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Rodney Hicks, AM, MBBS(Hons), MD, FRACP, FICIS, FAAHMS
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| Oliver Sartor is joined by Rodney Hicks to discuss PSMA PET imaging capabilities using the Siemens Biograph Quadra scanner. Dr. Hicks explains that this scanner's one-meter axial field of view provides 10-20x higher sensitivity than conventional scanners, enabling dynamic imaging and 30-second to one-minute high-quality acquisitions.
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Integrating PSMA PET Imaging: From Interpretation to Systemic Therapy Selection in Castration-Resistant Prostate Cancer
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A. Oliver Sartor, MD
Phillip Koo speaks with Oliver Sartor about integrating PSMA PET imaging in hormone-resistant pre-chemotherapy settings. Dr. Sartor advocates for obtaining PSMA PET scans relatively early when PSA rises after androgen deprivation therapy to identify oligometastatic disease.
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| PSMACare Trial-In-Progress: A Phase II Trial of [177Lu]Lu-PSMA-617 With or Without ARPI in Patients with PSMA-Positive Nonmetastatic Castration-Resistant Prostate Cancer
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| Fred Saad, MD, FRCSC
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| PSMACare is a phase II study testing whether adding an ARPI to 177Lu177LuLu-PSMA-617 can improve outcomes in PSMA-positive nmCRPC, a setting where most patients are PSMA-avid but many still progress to metastases within 5 years. The trial will enroll about 120 patients, with PSA response as the primary endpoint, and aims to clarify whether radioligand therapy plus hormonal intensification can delay metastatic progression better than radioligand therapy alone.
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| Incorporating PSMA PETs in Registrational Trials
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| Alicia Morgans, MD, MPH
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| Alicia Morgans argued that PSMA PET is now integral to the prostate cancer treatment algorithm, so registrational trials should incorporate it rather than ignore it. Using ARASTEP as an example, she showed that blinded central review, randomized design, and supportive conventional-imaging and survival endpoints are essential to keep PSMA PET-based primary endpoints credible and clinically interpretable.
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| Does What We See on PSMA PET Matter?
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| Peter Choyke, MD, FACR
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| Peter Choyke highlights the use of PSMA PET in the diagnosis and staging of patients, as well as selecting mCRPC patients for 177Lu-PSMA-617, is well established. But, there are still some questions regarding the impact on long-term outcomes for utilization of PSMA PET in the biochemical recurrence setting. Dr. Choyke emphasizes that PSMA PET is finding recurrence earlier, but in biochemical recurrence that can push men into earlier and more intensive treatment without proof that outcomes improve.
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| SPECT versus PET: Optimizing Response Biomarkers
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| Lisa Bodei, MD, PhD
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| Lisa Bodei argued that PET and SPECT should be viewed as complementary biomarkers in PSMA theranostics: PET is best for baseline selection and whole-body response assessment, while SPECT is a practical on-treatment tool that can track dosimetry and early response during therapy. Her main take-home was that baseline PSMA PET SUVmean, whole-body tumor metrics, and early SPECT changes can predict PSA response and survival better than PSA alone, making response assessment more precise.
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| What Is next After Clinical Trials Testing PSMA & Lutetium-177?
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| Jeremie Calais, MD, MSc, PhD
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| Jeremie Calais argued that the next step after successful PSMA-lutetium trials is to move earlier in the disease course and combine radioligand therapy with ARPIs, PARP inhibitors, chemotherapy, or alpha emitters to overcome resistance. He also emphasized that future progress will depend on better patient selection, dosimetry, and novel radionuclides or targets beyond PSMA, not just repeating the same Lu-177 strategy.
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