Imaging and therapy targeting PSMA receptors for enhanced vision and precise treatment

Summary In Europe, it is estimated that more than 65,000 men die each year from the consequences of advanced and metastatic prostate cancer (PCa). Currently, approximately 3.2 million European men are living with PCa. While the majority of PCa patients have favorable outcomes, the 5‑year relative survival rate for those with metastatic PCa is only 32%. Recent advances in the diagnosis of PCa have been boosted by the introduction of the prostate-specific membrane antigen (PSMA), which might identify patients with the most aggressive form of the disease. Molecular imaging with positron emission tomography (PET) targeting PSMA receptors (PSMA-PET) has utterly revolutionized the diagnosis and staging of PCa; however, its application is still under debate. On the one hand, there has been little progress in recent years in surpassing the limitations of androgen deprivation therapy (ADT), the backbone of metastatic PCa treatment. Adding additional systemic therapy became standard in the last few decades. Current ADT is only transiently effective, and patients eventually progress during ADT treatment, a condition known as castration-resistant PCa (CRPC). On the other hand, radioligand therapy (RLT) targeting these PSMA receptors, most commonly used in the studies [ 177 Lu]lutetium-PSMA-617, has been available for this cancer stage for nearly a decade and has been recently incorporated into the European Association of Urology (EAU) guidelines as a robust treatment option for patients with metastatic CRPC.