PSMA PET → PSMA radioligand therapy
The scan shows whether the target is there; the treatment uses the same address. Only patients whose tumours light up are treated.
Overview
This diagnostic-therapeutic pairing links PSMA PET to Radioligand therapy (beta emitters) against PSMA in Prostate cancer: the scan shows whether the target is there, the treatment uses the same address, and only patients whose tumours light up are treated. Identical ligand chemistry means imaging biodistribution predicts therapeutic biodistribution and enables dosimetry. VISION and PSMAfore required PSMA PET positivity, so the pairing is embedded in phase 3 design and drug labels, and the standardised uptake value predicts response. The linked agents are Piflufolastat F-18 / Pylarify TruVu and Lutetium-177 vipivotide tetraxetan, and the pairing is the archetype of Theranostics now being copied for FAP, TROP2, HER2 and CAIX.
This guideline tells doctors and insurers exactly which clinical situations justify a PSMA PET scan for prostate cancer - mainly staging higher-risk disease, investigating a PSA rise after treatment, and checking that a patient's cancer will respond to PSMA radioligand therapy - and which situations do not.
Men with metastatic castration-resistant prostate cancer that has progressed after hormonal therapy and chemotherapy, and whose tumours show PSMA on a PET scan, can now receive lutetium-PSMA, which extends life, controls pain and is usually better tolerated than further chemotherapy. It has established a new treatment class in which a scan decides who gets the matching radioactive drug, and it is now being tested earlier in the disease (PSMAfore, PSMAddition).
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