Steven Finkelstein: Well, thank you so much for having me. Really excited here to be at AUA 2026 and it's amazing to see how far radiopharmaceuticals have come. My talk was really focused on where we are, where we're going, the excitement, the tidal wave that is the excitement of radiopharmaceuticals. So speaking of lutetium, so built on the backbone of exciting trial work some years ago on VISION. Radiopharmaceuticals with a beta emitter, lutetium, also known as Pluvicto, have really permeated the mindset of prostate cancer patients and physicians. I talked a little bit about in this presentation the fact that we're using this much more frequently in the pre-chemotherapy space.
Zachary Klaassen: Right.
Steven Finkelstein: Patients are coming in saying, "I would really like to hear about this. I'd really like to see if I'm eligible for therapy that does not necessarily use chemotherapy." There are nuances to that. Some of those nuances I went through about who make good patient selections, and maybe we'll talk a little bit about imaging and how that drives the flow of the therapeutic part, but really exciting times for the world of radiation therapy, for the world of radiopharmaceuticals.
Zachary Klaassen: Yeah, absolutely. Great summary, and I think, let's go back to that imaging. Why is imaging so important? Why is it the backbone of everything we think about radioligand therapy wise?
Steven Finkelstein: When we think about lutetium and Pluvicto, you cannot, you cannot get that therapy unless you have a PSMA PET that shows the disease. So it ties a diagnostic finding where the cancer is using PSMA PET and then delivering a therapeutic product that's designed to go after. That's what theranostics is. And I was fortunate to publish a recent paper, which I'm the senior author of with a team of investigators to really go look at that.
Zachary Klaassen: Yeah, and let's dig into that. This is the MD PET 1, so multidisciplinary PET. And you guys had a beautiful table, Theranostic just published a few months ago. And it's really multidisciplinary at this point, isn't it? Whether it's urologist, rad onc, nuc med, radiologist, everybody tied in. Maybe give us some highlights from that paper.
Steven Finkelstein: Yeah. So what I talked about in the presentation and we have in press is we put together a group of luminaries across different kinds of specialties. I truly believe that prostate cancer is best taken care of when it's taken care of together as a team. And so we had radiation oncologists, urologists, nuclear medicine physicians. The gamut of specialties come together in a two-year initiative to write what we think is the standard, the guidelines for 2026. Just a summary of what that looks like is we think that PET can be used in a variety of settings. Again, it can be used for the setting I mentioned, which is to obtain imaging before the ability to give a radiopharmaceutical and theranostics. But it's so also imported in definitive staging for prostate cancer, for trying to figure out patients who are high risk, do they really have high risk or do they have metastatic disease?
Zachary Klaassen: Sure.
Steven Finkelstein: I think one of the emerging things that you'll see in the paper as well is we are very interested in seeing PET transition in the post-therapy stage, being able to use that kind of tech in the appropriate way. I think it's hard and it doesn't make as much sense in 2026 using conventional imaging on the backend when you're using so much of the fancy next-generation imaging on the front end.
We have to figure out a way to integrate that in a logical, reasonable way. I think the MD PET 1 starts to set the framework for that. There's been a lot of interesting things in the world, the prostate cancer working group four, changing definitions, and things like that as I talk about in my presentation. But I think the MD PET 1 paper really sets the guidelines for the use of PSMA PET in the settings that we just talked about.
Zachary Klaassen: Yeah. Great summary. I want to conclude with what's coming down the pipeline. Lutetium obviously has been in the forefront of our minds for a few years now. What's coming down the pipeline you're excited about from an RLT standpoint?
Steven Finkelstein: I think there's so many exciting radiopharmaceuticals coming down the pike. We started and we cut our teeth really in the excitement with alpha emitters. Alpha emitters, radium-223, Xofigo, combines the ability to give radiation agents and with the benefits of alpha potentially over beta, utilizing that to hit the cancer targets and avoid collateral damage.
Obviously, lutetium has captured the minds of many, many patients and physicians and it's exciting for me having giving the first pre-chemotherapy dose of it. Now there's alpha emitters that do the same thing that we're trying to do or have done with beta emitters, actinium. There's also things that are coming down the pike with lead and copper. I think that really a tidal wave of enthusiasm built on a backbone of lutetium, as I talked about in my presentation here at AUA is going to lead to five years from now we'll be talking about the gamut of which of these radiopharmaceutical agents to employ in the right patients.
Zachary Klaassen: Yeah, absolutely. Steve, thanks for joining us at the International Prostate Forum on UroToday to talk about it. Anything take-home wise for our listeners?
Steven Finkelstein: Yeah, I think for prostate cancer patients, working together, urologists, radiation oncologists, nuclear medicine physicians, we're pulling for you. We're going to work together as a team. If MD PET 1 taught me anything, it's about how important we all pull together to fight for our patients and really try to win the war against prostate cancer.
Zachary Klaassen: Well summarized. Steve, thanks for joining us on your own today.
Steven Finkelstein: Thank you so much.