Conventional systemic therapies are valuable options in prostate cancer (PCa); however, such treatments can determine adverse events and toxicity. The observed improvement in overall survival, coupled with PSA reduction and a favorable safety profile in the post-taxane castration-resistant PCa (CRPC) setting has prompted the consideration of PSMA-based radioligand therapy (RLT) earlier in the treatment sequence. In this review, we will describe the literature and ongoing clinical trials regarding the use of PSMA-based RLT in hormone-sensitive PCa (HSPC) including the neoadjuvant, de-novo/synchronous metastatic, adjuvant, and early BCR settings.
We performed a systematic literature search on the PubMed/MEDLINE/EMBASE and clinicaltrials.gov databases for studies and protocols assessing the role of PSMA-based RLT in HSPC.
The literature search yielded 140 results. After screening titles and abstracts and applying inclusion and exclusion criteria, we selected 25 papers showing the potentialities of earlier RLT in HSPC, with several ongoing trials.
Early use of PSMA-based RLT holds significant potential in HSPC patients from the neoadjuvant to the BCR setting. In these stages, the lower tumor burden, more frequent exclusive nodal involvement, and higher organ reserve may improve treatment efficacy and allow for treatment combinations while maintaining a less toxic profile.
European journal of nuclear medicine and molecular imaging. 2025 Feb 12 [Epub ahead of print]
Riccardo Laudicella, Matteo Bauckneht, Irene A Burger, Alberto Cacciola, Stefano Fanti, Andrea Farolfi, Vincenzo Ficarra, Andrei Iagaru, Virginia Liberini, Stefano Pergolizzi, Giulia Santo, Irene Virgolini, Fabio Minutoli, Sergio Baldari
Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy., IRCCS Ospedale Policlinico San Martino, Genova, Italy., Department of Nuclear Medicine, University Hospital Zürich, University of Zurich, Zurich, Switzerland. ., Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy., Nuclear Medicine Division, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy., Nuclear Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy., Gaetano Barresi Department of Human and Paediatric Pathology, Urologic Section, University of Messina, Messina, Italy., Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, Stanford, USA., Nuclear Medicine Unit, ASO S.Croce e Carle Cuneo, Cuneo, Italy., Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, Messina, Italy., Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria.