<p>The early detection of potentially lethal prostate cancer is currently not possible, and more accurate prognostics are needed. These could potentially be used to determine when to use radioligand therapy (RLT) earlier while avoiding overtreatment. At the <strong>2024 Society of Nuclear Medicine & Molecular Imaging (SNMMI) Annual Meeting</strong>, a session discussed the earlier use of RLT in prostate cancer.</p> <p><em> </em></p> <p><em> </em></p> <p><em>Following this session, featured expert Daniel P. Petrylak, MD, was interviewed by </em>Conference Reporter<em> Editor-in-Chief Tom Iarocci, MD. Dr Petrylak’s clinical perspectives on these findings are presented here</em><em>.</em></p> <p> </p>

We are still fairly far away from achieving the early identification of patients with potentially lethal prostate cancer. Risk stratification remains complex, and this could lead to undertreatment or overtreatment. To try to risk stratify, you can use 22-gene assays to help inform treatment decisions. For example, we know that prostate cancer with BRCA1/2 mutations tends to behave more aggressively. However, we still do not have accurate ways of prognosticating.

 

The optimal path for the early detection of recurrence after definitive therapy remains unclear. We are still working to understand the role of all the different treatments for metastatic disease that are emerging. The question is: How do you prevent yourself from overtreating these patients? That is a major issue of concern. Prostate-specific membrane antigen positron emission tomography (PSMA PET) is most often used in patients who we think have a high probability of metastases. In patients with small-volume oligometastases, you can potentially radiate.

 

During a PSMA RLT tumor board session at the 2024 SNMMI Annual Meeting, the following question was raised: Is RLT better when given earlier in patients with metastatic disease? My thought is that you should think about radiating all the metastatic sites and you should not think about using RLT in these patients because we still do not know if using it might be overkill. For example, if you are making RLT treatment decisions based on the PSMA PET imaging, are you sure that what you have is real? There are issues in terms of bone metastases to the ribs, as they tend to have a false-positive rate. Similarly, what are thought to be metastases in the thyroid could actually be a thyroid primary.