TY - JOUR T1 - Radionuclide Therapy in Prostate Cancer: From Standalone to Combination PSMA Theranostics JF - Journal of Nuclear Medicine JO - J Nucl Med SP - 1660 LP - 1668 DO - 10.2967/jnumed.120.243295 VL - 62 IS - 12 AU - Shahneen Sandhu AU - Christina Guo AU - Michael S. Hofman Y1 - 2021/12/01 UR - http://jnm.snmjournals.org/content/62/12/1660.abstract N2 - Despite significant advances in therapeutic developments for prostate cancer over the last 2 decades, metastatic prostate cancer remains a lethal disease. Prostate-specific membrane antigen (PSMA), which is markedly overexpressed in prostate cancer cells and metastatic sites but has low normal-tissue expression, has emerged as an important theranostic target for this disease. Both β-emitting and α-emitting PSMA-targeted radionuclide therapy (RNT) are in clinical development. Several of these agents have already shown promising activity; however, a subset of patients have primary resistant disease, and secondary resistance invariably occurs. Further, the effect of these therapies on healthy organs limits their therapeutic window. Elucidating the biology of PSMA and characterizing the pharmacokinetic and pharmacodynamic properties of PSMA-targeted RNT and mechanisms of resistance will facilitate therapeutic approaches aimed at improving efficacy and safety. In this review, we provide an overview of existing PSMA-targeting RNT and novel RNT combinatorial approaches, such as those with novel hormonal agents, poly-[adenosine diphosphate-ribose]-polymerase inhibitors and immunotherapy, currently under investigation. ER -