Wolfgang Weber, MD

Wolfgang Weber, MD, Professor and Chair of the Department of Nuclear Medicine at the Technical University of Munich in Germany (TUM), reviews a half-decade of progress in the field of prostate cancer imaging and theranostics. First, he introduces glutamate carboxypeptidase, which is highly expressed in primary and metastatic prostate cancer. Dr. Weber then compares different PSMA ligands for PET imaging, finding that GA-PSMA-11 has extensive clinical experience but has small batch sizes; GA-THP-PSMA is very easy to label and has a lower uptake by normal organs but also has small batch sizes, renal excretion, and lower tumor uptake; F-DCFPyL has large batch production but renal excretion; F-PSMA-1007 has large batches and low renal excretion but suffers from a higher frequency of non-specific uptake; and F-rhPSMA-7.3 has large batches and low renal excretion but higher frequency of non-specific uptake. He displays a graph comparing the focal uptake in benign lesions between GA-PSMA-11 and F-PSMA-1007, revealing that GA-PSMA-11 is only displayed in 52 lesions vs. F-PSMA-1007’s 542. Dr. Weber then reviews a study of a specific patient who experienced normalization after 4 treatment cycles to depict the possible effectiveness of ligands. However, he observes that such success is not true for all patients, citing a study of the clinical experience in 100 consecutive mCRPC patients treated with Lu-177 PSMA I and T, finding a median of 12.9 months of survival for patients. Another similar study found a median of 13.5 months of survival for patients. Dr. Weber concludes by looking at a comparison of Lu-PSMA-617 and cabazitaxel which suggests that Lu-PSMA-617 is more effective and could be used to treat earlier stages of prostate cancer.