PSMA-PET Highlights Evolution of Molecular Imaging in Prostate Cancer

Andrei H. Iagaru, MD

The approval and implementation of prostate-specific membrane antigen PET (PSMA-PET) scans have highlighted the advancement of molecular imaging for patients with prostate cancer. However, additional education and clarity are needed so institutions that conduct the scans and practices that use the results can work together to guide treatment for patients, according to Andrei H. Iagaru, MD.

“We are still learning a lot [about PSMA-PET]. Although many phase 3 trials have been completed, we’re now looking at expanding the use [of PSMA-PET], finding utilization for proper patient stratification, as well as the predictive value of PET,” Iagaru said in an interview OncLive^®.

In the interview during the 2023 Prost8 Cancer Conference, Iagaru, a professor of radiology - nuclear medicine and chief of the Division of Nuclear Medicine and Molecular Imaging at Stanford University Medical Center in California, discussed his presentation on molecular imaging in prostate cancer and highlighted other key presentations from the meeting.

OncLive^®: Please expand on the topic that you presented at the 2023 Prost8 Cancer Conference, regarding management of mHSPC. What were the key points that you raised?

Iagaru: I was honored to be invited to present in this esteemed forum of key opinion leaders in prostate cancer. The topic that I addressed [involved] advances in molecular imaging. I touched particularly upon the approval of PSMA-PET.

I spoke about the importance of high-quality PET scanning, about using the appropriate criteria and procedure standards from the Society of Nuclear Medicine and Molecular Imaging. I also mentioned to the audience that nuclear medicine as a community is working on introducing standards, both for how the exams are acquired, as well as how the results are sent back to the referring physicians and to the patient, so that we ultimately speak the same language, regardless of the institution where these scans are being provided.

What clinical trial data contributed to your discussion?

[I discussed] a phase 3 trial that led to the [FDA approval of] Gallium 68 PSMA-11 in December 2020, as well as the [phase 3] CONDOR study [NCT03739684] that led to the [FDA approval of] piflufolastat F 18[¹⁸F-DCFPyL; Pylarify] in May 2021.

I also presented some of our own published data from a large cohort in an expanded research-access program, also using ¹⁸F-DCFPyL.

What is the importance of addressing how clinical trials are designed for patients with prostate cancer?

The issue of [clinical] trial design and how things can vary between institutions and locations [demonstrates that] a consensus needs to be built in order for the community to practice properly once [therapies] are approved.

How would you classify the current state of investigating new strategies across the field of prostate cancer?

I was pleasantly impressed by the amount of high-quality research that’s going on in various areas across the entire spectrum of prostate cancer. For example, in neuroendocrine prostate cancer, novel targets [are emerging] for therapies, as well as the use of PARP inhibitors.

What does a meeting like the Prost8 Cancer Conference contribute to the field of prostate cancer?

Just by bringing people from different specialties [and] from different institutions together [in the same room], we can exchange ideas. [For example,] we were sitting in one of the breaks and came up with [other] ideas for collaboration with other institutions.