Achieve the Objective of an Innovative Approach to Prostate Cancer Treatment – By Dr Harold Gunatillake

Revolutionising Care in Prostate Cancer Management

Overview

Exploring the treatment options for prostatic cancer and the exciting new advancements in theranostic techniques is a journey into cutting- edge medicine. These developments hold great promise for tailored therapies that can significantly improve patient outcomes. It’s an inspiring field that combines innovation with care, aiming to provide the best possible paths to recovery for those affected.

(Theranostics is a medical methodology integrating diagnostic imaging and therapeutic treatment within a single process. It frequently employs radioactive substances referred to as radiotracers. These radiotracers are specifically engineered to selectively target and adhere to particular cancerous cells, thereby enabling medical practitioners to visualise the localisation of the tumour (diagnostic) and subsequently administer targeted radiation therapy aimed at eradicating those cells (therapeutic).

Prostate Cancer is the deadliest cancer among men, becoming more visible with ageing, like breast cancer in women.

Prostate cancer ranks as the second-deadliest cancer among men in the United States, and its prevalence is increasing. Each year, over 300,000 men receive a diagnosis of this condition, a figure that has been rising at an annual rate of 3% since 2014, as reported by the American Cancer Society.

Screening methods have improved, men live longer, and this increases dramatically with age. Still, in most cases, with early diagnosis and progress slowly, one in 44 men will die from it.

Today, the primary test for prostate cancer is Prostate-Specific Antigen (PSA). Your doctor will suggest it when you reach the age of 60 years.

Generally, when a PSA level exceeds 4.0 ng/ml, it’s seen as abnormal, which might lead to a recommendation for a prostate biopsy. However, since PSA levels tend to rise with age, some doctors prefer a higher threshold, like five ng/ml, for older men and a lower one, around 2.5 ng/ml, for younger men.

Let us set aside the conventional approach to managing these cases and concentrate on a novel method for addressing the disease that is rapidly progressing in the field of nuclear medicine: an advancement referred to as theranostics.

Theranostic Techniques: The Latest Frontier

Theranostics, a combination of “therapy” and “diagnostics,” is an innovative approach integrating molecular imaging and targeted treatment. In prostate cancer, theranostics is revolutionising care by enabling precise diagnosis and personalised therapy.

PSMA-Targeted Theranostics

Prostate-specific membrane antigen (PSMA) is a protein abundantly expressed in prostate cancer cells. Theranostic techniques utilise PSMA as a biomarker for both detecting and treating prostate cancer. Radioligands like PSMA PET imaging agents are used for diagnosis, while PSMA-targeted radioligand therapy (RLT) delivers radioactive material directly to cancer cells.

How Does Theranostics Work?

The foundational detect-and-destroy principle of theranostics originates from the 1940s, specifically with the application of radioactive iodine in treating thyroid cancer. However, recent advancements in imaging technology and cancer therapies have significantly progressed within this domain. Prominent pharmaceutical companies, such as Novartis and Lilly, have allocated substantial financial resources, amounting to billions, towards developing or acquiring radiopharmaceuticals, which are the radioactive agents that facilitate theranostics.

Theranostic Techniques: The Latest Frontier

Theranostics, blending “therapy” and “diagnostics,” is an exciting and innovative approach that seamlessly integrates molecular imaging with targeted treatment. When it comes to prostate cancer, theranostics is truly transforming care by allowing for precise diagnosis and personalised therapy that meets each patient’s unique needs.

The diagnostic component of theranostics involves tests, often utilising a PET scan, wherein a radiopharmaceutical drug known as a radiotracer is administered to the patient. This radiotracer binds to cancerous cells, thereby revealing them through the imaging scans. In the case of prostate cancer, the radiotracer specifically targets prostate-specific membrane antigens (PSMA) expressed by the cancer cells.

Following this pathway, a therapeutic approach is employed to target the cancer cells, effectively destroying them with precision while preserving most healthy tissue.

“We can deliver a high radiation dose to that specific area and maintain it within only one to two millimetres,” stated Daryl Eber, MD, a diagnostic radiologist and nuclear medicine physician in Miami. He is the owner and operator of 3T Radiology & Research, a private practice that is acquiring the necessary technology to offer theranostics to patients.

Radioligand Therapy (RLT)

One of the most promising theranostic treatments is radioligand therapy, particularly involving molecules such as Lutetium-177 PSMA (Lu-177 PSMA). This therapy employs radioactive isotopes conjugated to PSMA-targeting agents, which enables the radioactive material to selectively eradicate prostate cancer cells while preserving healthy tissue. Research has demonstrated remarkable outcomes, including extended survival and enhanced quality of life for patients suffering from metastatic prostate cancer.

Integration of Artificial Intelligence

Recent advancements in theranostics include the use of artificial intelligence (AI). AI algorithms assist in analysing imaging results, predicting treatment outcomes, and optimising radioligand dosages tailored to individual patients. This approach promotes more precise and personalized patient care.

Advantages of Theranostics in Prostate Cancer

• Theranostic techniques provide numerous unparalleled advantages:
• Precision: Theranostics accurately identifies cancer cells, thereby facilitating targeted therapy.
• Minimised Side Effects: Theranostic treatments diminish collateral damage to healthy tissues by concentrating solely on malignant cells.
• Personalisation: This methodology customises treatment plans according to the specific biological characteristics of the patient’s cancer.
• Improved Outcomes: Patients receiving theranostic treatments frequently exhibit improved survival rates and a superior quality of life.

Future Prospects

The exciting field of theranostics is flourishing, with ongoing research uncovering new radioligands and innovative combination therapies. Advances in nanotechnology are especially promising, as nanoparticles can act as carriers for therapeutic agents, ensuring that treatments are even more targeted and effective.

Conclusion

Thanks to the exciting advent of theranostic techniques, the treatment of prostate cancer is truly experiencing a transformative phase. Theranostics offers a more accurate, effective, and

patient-centred approach to managing the disease by seamlessly connecting diagnostics and therapy. With ongoing research, these innovative treatments are set to redefine the landscape of prostate cancer care, bringing hope to millions of patients around the globe.

These are the blessings of new therapeutic techniques for the betterment of mankind.

 

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