Dr. Iagaru on Advancements in PSMA-PET Imaging for Prostate Cancer

Andrei H. Iagaru, MD, professor of radiology - nuclear medicine, chief, Division of Nuclear Medicine and Molecular Imaging, Stanford University Medical Center, discusses the use of novel vs conventional imaging to manage metastatic hormone-sensitive prostate cancer (mHSPC).

The first prostate-specific membrane antigen (PSMA) radiopharmaceutical, Gallium 68 PSMA-11 (68Ga-PSMA-11), was approved by the FDA on December 1, 2020, for PET imaging of PSMA-positive lesions in patients with prostate cancer. This was followed by the approval of the PSMA-PET imaging agent piflufolastat F 18(18F-DCFPyL; Pylarify) on May 27, 2021, in the same population based on findings from the phase 3 CONDOR study (NCT03739684).

These approvals are representative of the significant advancement of molecular imaging techniques for prostate cancer. However, it is important to provide more guidance on the optimal use of PSMA-PET and facilitate collaboration between academic centers and clinical practices to best apply results.

Although several completed phase 3 trials have supported the increasing use of PSMA-PET imaging in clinical practice for mHSPC, current research efforts aim to expand its use in different patient populations. To accomplish this task, patient identification needs to be improved, and the predictive value of PSMA-PET imaging should be more firmly established.

It is also important to ensure high-quality imaging through adherence to specific guidelines and best practices both in academic centers and in the community. Educating clinicians on appropriate-use criteria and procedure standards from the Society of Nuclear Medicine and Molecular Imaging are critical to achieving accurate and effective scans. Moreover, the field of nuclear medicine aims to introduce guidelines for how exams are acquired and results are applied. This will improve collaboration between referring physicians and institutions conducting the scan when identifying the best treatment approach for patients.

Editor’s Note: Dr. Iagaru reports serving in a consulting or advisory role for Clarity Pharmaceuticals, Isotopen Technologien, Telix Pharmaceuticals; he received institutional research funding from Advanced Accelerator Applications, GE Healthcare, Progenics.