Department of Nuclear Medicine, "Santa Maria Goretti" Hospital, Via Antonio Canova, 04100 Latina, Italy.
Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, viale Regina Elena 324, 00100 Rome, Italy.
Int J Mol Sci. 2021 Mar 16;22(6):3036. doi: 10.3390/ijms22063036.
Metastatic castration-resistant prostate cancer (mCRPC) represents a condition of progressive disease in spite of androgen deprivation therapy (ADT), with a broad spectrum of manifestations ranging from no symptoms to severe debilitation due to bone or visceral metastatization. The management of mCRPC has been profoundly modified by introducing novel therapeutic tools such as antiandrogen drugs (i.e., abiraterone acetate and enzalutamide), immunotherapy through sipuleucel-T, and targeted alpha therapy (TAT). This variety of approaches calls for unmet need of biomarkers suitable for patients' pre-treatment selection and prognostic stratification. In this scenario, imaging with positron emission computed tomography (PET/CT) presents great and still unexplored potential to detect specific molecular and metabolic signatures, some of whom, such as the prostate specific membrane antigen (PSMA), can also be exploited as therapeutic targets, thus combining diagnosis and therapy in the so-called "theranostic" approach. In this review, we performed a web-based and desktop literature research to investigate the prognostic and theranostic potential of several PET imaging probes, such as F-FDG, F-choline and Ga-PSMA-11, also covering the emerging tracers still in a pre-clinical phase (e.g., PARP-inhibitors' analogs and the radioligands binding to gastrin releasing peptide receptors/GRPR), highlighting their potential for defining personalized care pathways in mCRPC.
转移性去势抵抗性前列腺癌（mCRPC）代表了一种尽管进行了雄激素剥夺治疗（ADT）但仍进展的疾病状态，其临床表现广泛，从无症状到因骨或内脏转移导致的严重虚弱不等。新型治疗工具的引入，如抗雄激素药物（即醋酸阿比特龙和恩扎鲁胺）、sipuleucel-T 的免疫疗法以及靶向 alpha 疗法（TAT），极大地改变了 mCRPC 的治疗方法。这种多样化的治疗方法需要寻找合适的生物标志物，以满足患者治疗前选择和预后分层的需求。在这种情况下，正电子发射计算机断层扫描（PET/CT）成像具有很大的潜力，可以检测到特定的分子和代谢特征，其中一些特征，如前列腺特异性膜抗原（PSMA），也可以被用作治疗靶点，从而在所谓的“诊断与治疗一体化”方法中结合诊断和治疗。在本综述中，我们进行了基于网络和桌面的文献研究，以探讨几种 PET 成像探针的预后和治疗潜力，如 F-FDG、F-胆碱和 Ga-PSMA-11，还涵盖了仍处于临床前阶段的新兴示踪剂（如 PARP 抑制剂类似物和与胃泌素释放肽受体/GRPR 结合的放射性配体），强调了它们在 mCRPC 中定义个性化治疗途径的潜力。
