SNMMI 2024

(UroToday.com) The 2024 Society of Nuclear Medicine & Molecular Imaging (SNMMI) annual meeting featured a session on prostate cancer, and a presentation by Dr. Louise Emmett discussing response assessment in radiopharmaceutical therapies for prostate cancer. Dr. Emmett started her presentation by noting that for patients with high PSMA SUVmean (quartile 4), PSA50 response rate to ¹⁷⁷Lu PSMA is excellent (89%). However, for those patients with low SUVmean (quartile 1) there is relatively poor ¹⁷⁷Lu PSMA PSA50 response rates (29%), but which are reasonable with cabazitaxel (43%):

(UroToday.com) The 2024 Society of Nuclear Medicine & Molecular Imaging (SNMMI) annual meeting featured a session on prostate cancer, and the Barry Siegel Award Lecture presentation by Dr. Steven Rowe discussing registrational trials for PSMA PET. Dr. Rowe started his presentation highlighting that PSMA is a transmembrane carboxypeptidase highly expressed on prostate cancer cells with frequent expression observed in prostate cancer tumors. Furthermore, there has been direct correlation between expression levels and tumor aggressive. What we know so far about PSMA PET is that it has (i) moderate sensitivity and very high specificity for preoperative nodal staging, (ii) high detection efficiency for sites of biochemical recurrence, and (iii) effective for guiding focal therapy and selecting patients for PSMA-based therapeutic molecules. ¹⁸F-DCFPyL in high risk prostate cancer patients can have vastly different staging results:

(UroToday.com) The 2024 Society of Nuclear Medicine & Molecular Imaging (SNMMI) annual meeting featured a session on prostate cancer, and a presentation by Dr. Raghava Karri discussing the prognostic value of post-therapy SPECT/CT imaging in patients undergoing ¹⁷⁷Lu-PSMA-617 (Lu-PSMA) radioligand therapy. Despite established efficacy of Lu-PSMA, as evidenced by the TheraP¹ and VISION² trials, there remains a notable gap in understanding the utility of post-therapy imaging. At the 2024 SNMMI annual meeting, Dr. Karri and colleagues reviewed changes on post-therapy SPECT/CT as a prognostic biomarker compared to PSA and conventional prognostic parameters in three clinical trials. 

(UroToday.com) The 2024 Society of Nuclear Medicine & Molecular Imaging (SNMMI) annual meeting featured a session on prostate cancer, and a presentation by Dr. Yongxiang Tang discussing an assessment of adverse pathological risk and proteomic biomarker correlations in prostate cancer.

(UroToday.com) The 2024 Society of Nuclear Medicine & Molecular Imaging (SNMMI) annual meeting featured a session on prostate cancer, and a presentation by Dr. Mina Swiha discussing the development of a visually calculated SUV_mean (HIT Score) on screening PSMA PET/CT to predict treatment response to ¹⁷⁷Lu PSMA therapy. ¹⁷⁷Lu-PSMA is an effective treatment in patients with metastatic castrate-resistant prostate cancer, and SUV_mean is a valuable screening biomarker to assess suitability for ¹⁷⁷Lu-PSMA therapy but requires quantitative software. This study aimed to develop a simple clinically applicable PSMA-PET score that encompasses the elements of SUV_mean, without requiring additional quantification.

(UroToday.com) The 2024 Society of Nuclear Medicine & Molecular Imaging (SNMMI) annual meeting featured a session on prostate cancer and a presentation by Dr. Seyed Ali Mirshahvalad discussing ¹⁸F-DCFPyL PET/MRI radiomics for intraprostatic prostate cancer detection and metastases prediction using whole-gland segmentation. The aim of this study presented at SNMMI 2024 was to evaluate the diagnostic performance of combined ¹⁸F-DCFPyL PET/MRI whole-gland-derived radiomics for detecting clinically significant prostate cancer (ISUP Gleason Grade ≥ 2) and predicting nodal and distant metastases in therapy-naïve patients.

(UroToday.com) The 2024 Society of Nuclear Medicine & Molecular Imaging (SNMMI) annual meeting featured a session on prostate cancer, and a presentation by Dr. Mina Swiha discussing a comparison of post-therapy 4 and 24-hour ¹⁷⁷Lu-PSMA SPECT/CT and pre-therapy PSMA PET/CT in assessment of disease in men with metastatic castrate-resistant prostate cancer.

(UroToday.com) The 2024 Society of Nuclear Medicine & Molecular Imaging (SNMMI) annual meeting featured a session on prostate cancer, and a presentation by Dr. Jiarou Wang discussing the diagnostic performance of ⁶⁸Ga-P16-093 in newly diagnosed prostate cancer. ⁶⁸Ga-P16-093 is a novel PSMA-targeted radiopharmaceutical that has a labeling reaction compatible with various Ge/Ga generators and has a simple labeling method of heating at 95 degrees Celsius for 5 minutes, leading to high radiochemical purity. As a targeting agent in prostate cancer patients, ⁶⁸Ga-P16-093 has the following compared to ⁶⁸Ga-PSMA:

(UroToday.com) The 2024 Society of Nuclear Medicine & Molecular Imaging (SNMMI) annual meeting featured a session on prostate cancer, and a presentation by Dr. Tao Sun discussing the simplified quantification method of [18F]AlF-P16-093 for patients with primary prostate cancer. This work presents the optimization of pharmacokinetic modeling for a new tracer, [18F]AlF-P16-093, for in-vivo prostate cancer imaging.

(UroToday.com) The 2024 Society of Nuclear Medicine & Molecular Imaging (SNMMI) annual meeting featured a session on prostate cancer, and a presentation by Dr. Jean-Mathieu Beauregard discussing a sub-analysis of the 3TMPO study assessing eligibility for PSMA radioligand therapy based on dual FDG/PSMA-PET. Eligibility criteria for PSMA radioligand therapy are currently debated, particularly with respect to the role of FDG-PET in patient selection.

(UroToday.com) The 2024 Society of Nuclear Medicine & Molecular Imaging (SNMMI) annual meeting featured a session on prostate cancer, and a presentation by Dr. Luke Nordquist discussing the results of COBRA, an assessment of the safety and efficacy of ⁶⁴Cu-SAR-bisPSMA in patients with biochemical recurrence of prostate cancer following definitive therapy. Between 20-40% of patients with prostate cancer will relapse within 10 years of their primary prostate cancer treatment, as identified by increasing PSA levels. Most relapses will occur within 5 years after definitive therapy, thus early diagnosis of biochemical recurrence with accurate staging is essential to inform the best treatment strategy. Over the last several years, PSMA has been used as an imaging target in prostate cancer.

(UroToday.com) The Society of Nuclear Medicine & Molecular Imaging (SNMMI) 2024 Annual Meeting held in Toronto, ON between June 8^th and June 11^th, 2024 was host to a prostate cancer novel approaches and combination therapies session. Dr. Hossein Jadvar discussed non-PSMA targets for prostate cancer radiopharmaceutical therapies, including:

(UroToday.com) The 2024 Society of Nuclear Medicine & Molecular Imaging (SNMMI) annual meeting featured a session on prostate cancer, and a presentation by Dr. James Buteau discussing radiation absorbed dose in patients with metastatic castration-resistant prostate cancer treated with ¹⁶¹Tb-PSMA-I&T. ¹⁷⁷Lu-PSMA is a proven therapy for patients with metastatic castration-resistant prostate cancer. Terbium-161 attaches to PSMA receptors and emits beta-particles similar to ¹⁷⁷Lu-PSMA, killing larger-sized tumors with abundant crossfire:

(UroToday.com) The 2024 Society of Nuclear Medicine & Molecular Imaging (SNMMI) annual meeting featured a session on prostate cancer, and a presentation by Dr. Linlin Li discussing the dosimetry and pilot therapy study of novel PSMA-targeting agents, ¹⁷⁷Lu-P17-087 and ¹⁷⁷Lu-P17-088, in metastatic castration-resistant prostate cancer patients. PSMA is a promising target for diagnosis and radioligand therapy of prostate cancer. Biodistribution and dosimetry of two novel PSMA-targeting radionuclide therapy agents, ¹⁷⁷Lu-P17-087, and its albumin binder-modified derivative, ¹⁷⁷Lu-P17-088, were evaluated in metastatic castration-resistant prostate cancer patients:

(UroToday.com) The 2024 Society of Nuclear Medicine & Molecular Imaging (SNMMI) annual meeting featured a session on prostate cancer, and a presentation by Dr. Jiarou Wang discussing preclinical and first-in-human studies of dansylated amino acid-modified long-acting PSMA derivative ⁶⁸Ga/¹⁷⁷Lu-LNC1011. ¹⁷⁷Lu-PSMA-617 has inadequate uptake and retention in tumors and poor diagnostic efficacy:

(UroToday.com) The 2024 Society of Nuclear Medicine and Molecular Imaging (SNMMI) annual meeting held in Toronto, ON between June 8 and June 11 was host to the session Novel Approaches and Combination Therapies; Pre-Targeting Approaches. Dr. Thomas Hope discussed the combination treatment of prostate cancer using Pembrolizumab with PSMA-based radioligands.

(UroToday.com) The 2024 Society of Nuclear Medicine & Molecular Imaging (SNMMI) annual meeting featured a session on prostate cancer, and a presentation by Dr. Nat Lenzo discussing preliminary results of ProstACT SELECT, specifically the safety, tolerability, and dosimetry of TLX591 with best standard of care in patients with PSMA-expressing metastatic castration resistant prostate cancer. PSMA has proven to be an ideal therapeutic target in prostate cancer. Monoclonal antibodies are distinguished by their internalization, long retention, and functional selectivity for tumor-expressed PSMA and can enable a short, patient-friendly dosing regimen with low occurrence of off-target side effects while delivering a meaningful therapeutic index.  (¹⁷⁷Lu) rosopatamab textraxetan (ie. TLX591) is a first-in-class radio-antibody drug conjugate investigational therapy that may be a potential treatment for prostate cancer, with previous clinical evidence supporting its favorable safety profile and specificity. TLX591 has been evaluated in more than 240 prostate cancer patients in eight phase 1/2 studies to date, with a 40+ month median overall survival in heavily pre-treated patients. Additionally, these studies demonstrated PSA response and dose-response profile for key measures of activity. Fractionated dosing manages hematologic safety while delivering a highly targeted and potent radiation dose to prostate cancer metastases.

(UroToday.com) The 2024 Society of Nuclear Medicine & Molecular Imaging (SNMMI) annual meeting featured a session on prostate cancer and a presentation by Dr. Dan Cohen discussing PSMA PET and insights gained from eight years of reimbursable imaging. Dr. Cohen started his presentation by highlighting that in January 2016, PSMA-based PET imaging was added to the Israeli national list of reimbursable health services. Subsequently, Israel emerged as one of the earliest countries in the world to apply PSMA-based PET in consecutive patients:

(UroToday.com) The 2024 Society of Nuclear Medicine & Molecular Imaging (SNMMI) annual meeting featured the Therapy Center of Excellence Saul Hertz Lecture and Award, and a presentation by Dr. Michael Hofman discussing bridging evidence-based medicine and precision oncology. Saul Hertz (1905-1950) conceived and brought from bench to bedside radioactive iodine for medical uses based on the 1936 question “Could iodine be made radioactive artificially?” This was followed by the 1937 radioactive iodine studies assessing thyroid physiology, tracer qualities, dosimetry, and thyroid carcinoma. On March 31, 1941, there was the first report of therapeutic use of radioactive iodine based on a series of 29 patients.

(UroToday.com) The 2024 Society of Nuclear Medicine & Molecular Imaging (SNMMI) annual meeting featured a session on prostate cancer, and a presentation by Dr. John Kennedy discussing technical considerations for diagnostic, quantitative, and dosimetric imaging for PSMA radioligand therapy in patients with prostate cancer. Dr. Kennedy started by highlighting that radiolabeled small molecules targeting PSMA are used for diagnostic imaging and treatment. This antigen is overexpressed in most prostate cancers but limited in non-prostatic tissues. Nevertheless, clinically, high uptake is observed in the salivary glands, duodenum, and kidneys. Moreover, there is a need for diagnostic, quantitative, dosimetric imaging, such as SPECT, dosimetry, PET, and theranostic pairs/triples. From a historical perspective, the first SPECT acquisition was in 1963, with the small circles of the outline (left) showing the relative location of the four iodine-131 sources, with the other images showing progressive back projection of acquired projections at differing angles: