Expanding Role of Positron Emission Tomography in Management of Prostate Cancer: Current Status and Future Directions

Introduction: To describe the diagnostic needs of patients with prostate cancer. To illustrate the utility of positron emission tomography (PET) to address those needs. To explain the complementary role of various radiotracers in the assessment of tumor biology with emphasis on radiopharmaceutical therapy (RPT).

Methods: Following the “scoping review” methodology, we performed a systematic literature search using five major medical databases, including PubMed. Standard protocols utilized for information retrieval, such as expansion of terms using thesaurus (e.g., MeSH). All the original articles related to prostate cancer and molecular imaging were included. Data extraction, critical appraisal of evidence, and knowledge synthesis were performed based on PRISMA-ScR. Conceptual mapping was performed to categorize the extracted knowledge for cohesive synthesis.

Results: The following conceptual topics identified as clinically relevant to be discussed: 1. Tumor biology of prostate cancer 2. Molecular and pharmacokinetic characteristics of the relevant radiotracers: metabolism [18F-FDG, 18F-Choline, 18F-Fluciclovine, 11C-Acetate], receptors [PSMA (68Ga-PSMA-11, 18F-Piflufolastat), GRPR (68Ga-DOTA-bombesin), SSR (68Ga-DOTATATE), AR (18F-FDHT)], and tumor microenvironment [FAPI, FMISO, 18F-NaF] 3. The role of each radiotracer based on the existing data 4. Pros and cons of RPT 5. Diagnostic needs at the point-of-care (localization of metastasis, identification of therapeutic contraindications, and stratification to select best candidates for precision RPT).

Conclusions: This educational exhibit will highlight the role of PET imaging with different radiotracers in the management of Prostate Cancer. We will discuss the advantages and limitations of each radiotracer.