Abstract:
Prostate cancer (PCa) causes significant morbidity and mortality in men globally. While
localized PCa may be managed with curative intent by surgery and/or radiation therapy, the management
of advanced hormone resistant metastatic disease (mCRPC) is more challenging. Theranostics
is a principle based on the ability to use an organ specific ligand and label it to both a diagnostic and
a therapeutic agent. The overexpression of prostate specific membrane antigen (PSMA) on prostate
cancer cells creates a unique opportunity for development of targeted radionuclide therapy. The use
of both beta and alpha emitting particles has shown great success. Several clinical trials have been
initiated assessing the efficacy and safety profile of these radionuclide agents. The results are encouraging
with PSMA directed radioligand therapy performing well in patients who have exhausted all
other standard treatment options. Future studies need to assess the timing of introduction of these
radionuclide therapies in the management schema of mCRPC. Drugs or therapies are not without
side effects and targeted radionuclide therapies presents a new set of toxicities including xerostomia
and myelosuppression. New therapeutic strategies are being explored to improve outcomes while
keeping toxicities to a minimum. This review aims to look at the various PSMA labelled tracers that
form part of the theragnostic approach and subsequently delve into the progress made in the area of
radionuclide therapy.