Division of Nuclear Medicine, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California
J Nucl Med. 2022 Jun;63(6):812-815. doi: 10.2967/jnumed.121.263274. Epub 2021 Dec 21.
Metastatic castration resistant prostate cancer (mCRPC) is incurable. The expression of the transmembrane protein prostate-specific membrane antigen (PSMA) is markedly increased in most mCRPC lesions. PSMA has been recognized as a viable biologic target for imaging and radionuclide therapy (theranostics) in mCRPC. The PET agents Ga-PSMA-11 and F-DCFPyL have recently been approved for imaging evaluation of patients with suspected metastasis who are candidates for initial definitive therapy and patients with suspected recurrence based on elevated serum prostate-specific antigen level. Radioligand therapy (RLT) with Lu-PSMA-617 (Lu-vipivotide tetraxetan, Pluvicto, Novartis/AAA) was approved on March 23, 2022, based on the favorable results of the VISION trial. It has been recognized that PET imaging of PSMA expression and glucose metabolism (with F-FDG) provides a more comprehensive assessment of the tumor burden and heterogeneity. However, there are many unresolved issues that surround whether or not imaging with F-FDG PET is advantageous in the clinical setting of PSMA RLT in mCRPR.
转移性去势抵抗性前列腺癌（mCRPC）是无法治愈的。大多数 mCRPC 病变中跨膜蛋白前列腺特异性膜抗原（PSMA）的表达显著增加。PSMA 已被认为是 mCRPC 中成像和放射性核素治疗（治疗诊断学）的可行生物靶标。PSMA 的 PET 示踪剂 Ga-PSMA-11 和 F-DCFPyL 最近已被批准用于疑似转移的患者进行初始确定性治疗和基于血清前列腺特异性抗原水平升高的疑似复发患者的成像评估。基于 VISION 试验的良好结果，Lu-PSMA-617（Lu-vipivotide tetraxetan，Pluvicto，诺华/AAA）的放射性配体治疗（RLT）于 2022 年 3 月 23 日获得批准。已经认识到，PSMA 表达和葡萄糖代谢（用 F-FDG）的 PET 成像提供了对肿瘤负担和异质性的更全面评估。然而，在 mCRPC 中 PSMA RLT 的临床环境中，是否进行 F-FDG PET 成像具有优势，仍存在许多悬而未决的问题。
