New Tool in Prostate Cancer Diagnosis and Treatment – PSMA PET Imaging and Radiopharmaceutical Therapy
Update Date：2025/02/07，
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Department of Nuclear Medicine, Radiation Therapist Chou Da-Kai / Physician Chen Yi-Feng
Prostate cancer incidence is increasing year by year, with rapid progression in advanced stages.
In recent years, the incidence of prostate cancer has been gradually rising. According to statistics from the Ministry of Health and Welfare, nearly 9,000 new cases of prostate cancer are reported annually in Taiwan, making it the fifth most common cancer among the top ten. The treatment of prostate cancer depends on the cancer's stage, grade, and the patient's overall health status. Early-stage patients without distant metastasis may consider surgical removal. However, some patients are diagnosed with distant metastasis only after experiencing long-term symptoms such as back pain. In such cases, further treatment with hormone therapy or radiation therapy may be necessary. Nevertheless, years later, cancer cells may develop resistance. Castration-resistant prostate cancer (CRPC) refers to prostate cancer that no longer responds to hormone therapy or castration. Patients with this condition typically require chemotherapy or radioactive isotope therapy, as the disease progresses rapidly and the prognosis is poor.
New Diagnostic Breakthrough: PSMA PET Imaging for Prostate Cancer
With advancements in nuclear medicine, a new class of PET imaging agents has been developed, using radioactive isotopes to label the prostate-specific membrane antigen (PSMA), which is highly specific to prostate cancer cells. Some of the most studied PET agents include Ga-68-PSMA-11, labeled with the radioactive isotope Ga-68, as well as F-18-labeled agents like F-18-DCFPyL, F-18-PSMA-1007, and F-18-rhPSMA-7.3. In Taiwan, both Ga-68-PSMA-11 and F-18-PSMA-1007 are currently used in clinical practice as options for prostate cancer PET scans.
Regardless of the specific PET agent, these imaging techniques offer higher sensitivity in detecting recurrent or metastatic lesions compared to traditional imaging methods. When the prostate-specific antigen (PSA) level exceeds 2 ng/mL, detection rates can exceed 90%, making PSMA PET imaging the best diagnostic tool for identifying prostate cancer lymph node involvement and distant metastases.
New Weapon Against Cancer: Prostate Cancer Radionuclide Therapy
Theranostics, the combination of diagnostic and therapeutic approaches, has emerged as a cutting-edge treatment strategy. By using Ga-68-PSMA-11 PET imaging to confirm the tumor location and select appropriate cases, followed by Lu-177-PSMA-617 radionuclide therapy, precise treatment can be achieved while minimizing damage to healthy tissues.
The U.S. Food and Drug Administration (FDA) has approved both Ga-68-PSMA-11 for diagnostic imaging and Lu-177-PSMA-617 for therapeutic treatment of prostate cancer. Research has shown that treatment with Lu-177-PSMA-617 can extend overall survival time, delay recurrence, and reduce skeletal-related complications in patients with metastatic castration-resistant prostate cancer. This offers a promising new treatment option for patients who have not responded to traditional therapies.