LUGPA 2026 Global Prostate Cancer Congress Enduring Program-Session 3

Video Transcription

Video Summary

Session 3 focuses on advances in imaging for prostate cancer, especially PET and MRI, and how they are reshaping diagnosis and treatment. Dr. Sharif Ghamlmi reviews PET tracer fundamentals and the shift from older FDG “glucose-avid” imaging to highly specific molecular tracers that identify receptors and biomarkers, enabling both precision diagnosis and theranostics (diagnostic and therapeutic use of similar ligands). He highlights rapid growth in available tracers and expanding applications beyond oncology (neurology, cardiology, inflammation), while emphasizing urology’s major role via PSMA PET. New PSMA variants aim to improve detection at low PSA, refine pharmacokinetics, and reduce kidney radiation. He also explains practical PET interpretation pitfalls: physiologic uptake differs by tracer; uptake can reflect inflammation/infection or post-radiation fibrosis; SUV values can be misleading; and diabetes can degrade FDG accuracy.<br /><br />Radiation oncologist Dr. Sean Collins explains how PSMA PET findings can meaningfully change salvage radiation fields after prostatectomy (e.g., adding pelvic nodes or treating uncommon perirectal spread). He cites a phase II randomized trial where PSMA PET–guided intensification improved failure-free survival (84% vs 69%) without increased toxicity. He also reviews data supporting SBRT plus short-course ADT for hormone-sensitive oligorecurrent disease and emerging evidence that metastasis-directed therapy may benefit selected oligometastatic castration-resistant patients by delaying progression and next-line therapy.<br /><br />Dr. Michael Liss discusses prostate MRI for guiding biopsies and risk stratification, detailing PI-RADS use, limitations (notably inflammation-related false positives), and the potential of AI tools to improve lesion visualization and possibly reduce repeat biopsies in active surveillance.<br /><br />A panel case underscores common challenges: equivocal rib lesions on PSMA PET, post-radiation prostate heterogeneity, over-imaging, and the importance of clinician image review and cautious management. The session ends with an abstract on CAPTEN, a randomized trial comparing MRI-guided transurethral ultrasound ablation (TULSA) versus robotic prostatectomy, showing early perioperative advantages for TULSA (minimal blood loss, outpatient treatment, less pain) with longer-term efficacy pending.

Keywords

prostate cancer imaging

PSMA PET

PET tracers

molecular imaging biomarkers

theranostics

salvage radiotherapy planning

oligometastatic disease

SBRT and short-course ADT

prostate MRI

PI-RADS

MRI-guided TULSA (CAPTEN trial)