LUGPA 2025 Global Prostate Cancer Congress Enduring Program-GPCC 2025 Session 5

Video Transcription

Video Summary

This detailed session focused on advanced imaging and therapeutic approaches in prostate cancer, emphasizing Molecular Targeted Imaging, particularly PSMA-PET, its clinical applications, and integration into practice.<br /><br />Dr. Amir Irmani reviewed four decades of PSMA-PET development highlighting FDA-approved agents like Gallium-68 PSMA-11 and F18-DCFPyL. He explained PSMA-PET’s high specificity but modest sensitivity, particularly in detecting small lymph node metastases in initial staging and biochemical recurrence. Clinical trials, including the PRO-PSMA trial, demonstrated PSMA-PET superiority over conventional imaging in sensitivity and management impact. PSMA-PET altered risk stratification and treatment decisions, though challenges like lead-time bias remain in proving long-term outcome benefits. Ongoing trials aim to clarify PSMA-PET’s clinical impact on intensified treatment strategies.<br /><br />Phil Kuh discussed patient case examples using PSMA-PET for selecting candidates for Lutetium-177 PSMA radioligand therapy (RLT), emphasizing that receptor expression verification via PSMA-PET is critical before therapy. He highlighted practical considerations including timing of imaging, interpreting SUV values cautiously, post-treatment imaging debates, and the value of complementary CT and bone scans to assess disease progression or response.<br /><br />Dr. Michael O’Donnell addressed integrating PET into urology practices, covering operational, regulatory, and financial aspects. He noted the importance of patient volume (around 30 scans/month) for profitability, infrastructure needs, and options including turnkey services.<br /><br />Dr. Laurence Klotz detailed micro-ultrasound technology as a complementary or alternative imaging to MRI, demonstrating its higher resolution, real-time capability, and limitations in large prostates or anterior zones. He reviewed recent data showing comparable or better detection sensitivity versus MRI and advocated micro-ultrasound’s potential to improve accessibility and streamline prostate cancer diagnosis at the urology clinic level.<br /><br />The panel concluded with discussion on AI-based prostate cancer mapping for extracapsular extension (ECE) risk assessment. An FDA-cleared AI tool combining imaging, biopsy, and clinical data outperformed expert MRI reads in predicting and localizing ECE, with implications for surgical planning and nerve-sparing techniques.<br /><br />Overall, the session underscored the evolving role of molecular imaging, advanced ultrasound, and AI in personalized prostate cancer management, integrating diagnostics and therapy to improve precision and patient outcomes.

Keywords

Prostate Cancer

PSMA-PET Imaging

Molecular Targeted Imaging

Gallium-68 PSMA-11

F18-DCFPyL

Lutetium-177 PSMA Radioligand Therapy

Micro-Ultrasound

Artificial Intelligence in Prostate Cancer

Extracapsular Extension Risk Assessment

Personalized Prostate Cancer Management