SNMMI Mars Shot: Prostate Cancer

Prostate cancer is the most commonly occurring cancer and the second leading cause of cancer deaths in men. In 2022, more than 268,000 cases of prostate cancer and approximately 34,500 deaths are projected in the United States. Although the five-year survival rate of localized prostate cancer is high, approximately 30% of men treated for prostate cancer will go on to develop biochemically recurrent cancer. Ten to twenty percent of men with prostate cancer develop metastatic castration-resistant prostate cancer (mCRPC) within five-years of diagnosis¹. Five-year survival for men with mCRPC is only 30 percent. 

Beyond mortality, prostate cancer treatment can have an immense impact on quality of life, with potential side effects including urinary dysfunction, bowel dysfunction, and erectile dysfunction. Early detection allows for quicker, more effective, and more appropriate treatment.


Nuclear medicine and molecular imaging have relevance at all stages of detection, treatment, and prognosis. Molecular imaging provides detailed information about the cancer, dramatically improving the accuracy of diagnosis and allowing for a personalized therapy based on the patient’s unique biology. Optimal use of imaging to make the diagnosis and determine the response to suggested therapies will allow for the greatest potential improvement in prognosis and in the future quality of a patient’s life. Developing new tracers and advancing software will allow for improved imaging and more precise treatment courses based on the expected aggressiveness and potential spread of the disease. As stated by Wolfgang Fendler, a nuclear medicine physician at Essen University Hospital in Germany, “The ultimate aim of imaging is to provide the right treatment for each patient.”²


A combined approach, known as theranostics (therapy and diagnostics), utilizes a diagnostic radioligand followed by a therapeutic radioligand. PET scans are obtained using a ligand with a diagnostic radioisotope to identify patients whose mCRPC cells express prostate specific membrane antigen (PSMA). Radiation is then selectively delivered to those cancer cells using the same ligand with a therapeutic radioisotope.


Radiopharmaceutical imaging and therapies are rapidly improving the efficacy of diagnosis and treatment of prostate cancer, as well as its prognosis. New research has confirmed the accuracy of the novel European Association of Urology risk classification system, which groups patients with prostate cancer on the basis of their risk of recurrence after first-line therapy (prostate surgery or radiation). The first radiopharmaceutical drug (68GA-PSMA-11) for PET imaging of PSMA-positive prostate cancer was approved on December 1, 2020, almost 10 years after its discovery. On March 23, 2022, the Food and Drug Administration approved a new, game-changing nuclear medicine treatment for mCRPC shown to reduce the risk of death by 38% and the risk of progression by 60%³.

As nuclear medicine advances, initial diagnostic imaging may allow us to formulate a full treatment course for prostate cancer, with more accurate prediction of suspected future recurrences. It is essential that PSMA PET be accurate to improve stratification and potential outcomes in both low-risk and high-risk patients. Investing in research and new treatments means prostate cancer will be detected earlier, and more effective therapies can provide a better prognosis.