European Urology Oncology Theranostics for Advanced Prostate Cancer: Current Indications and Future Developments  Andrea Farolfi, Wolfgang Fendler, Amir Iravani, Uwe Haberkorn, Rodney Hicks, Ken Herrmann, Jochen Walz, Stefano Fanti  European Urology Oncology  DOI: 10.1016/j.euo.2019.01.001 Copyright © 2019 European Association of Urology Terms and Conditions

Fig. 1 A 75-yr-old patient with GS 7 metastatic CRPC with PSA progression during therapy with abiraterone. Prior treatments were sequenced as follows: radical prostatectomy, salvage RT, and ADT. Images show that progression of disease during therapy with abiraterone. PSA at the first 68Ga-PSMA-11 PET was 0.61ng/ml and maximum intensity projection (MIP) showed pathological PSMA uptake at the right scapula (SUVmax=7.7), the left humerus, and the 10th thoracic vertebra (left images). Three months later PSA was 1.19ng/ml, and 68Ga-PSMA-11 PET MIP revealed increased PSMA uptake of all the previously described bone lesions (SUVmax=29.3, right scapula) and the appearance of other suspected lesions at the sternum and at the sacrum (right images). In this patient, during therapy with abiraterone, there is a PSA serum level increase together with a higher PSMA uptake in the known lesions and the appearance of new lesions compared with the first PSMA scan. ADT=androgen deprivation therapy; CRPC=castration-resistant prostate cancer; GS=Gleason score; PET=positron emission tomography; PSA=prostate-specific antigen; PSMA=prostate-specific membrane antigen; RT=radiotherapy; SUV=standardized uptake value. (Case courtesy of S. Orsola-Malpighi University Hospital, Bologna, Italy.) European Urology Oncology DOI: (10.1016/j.euo.2019.01.001) Copyright © 2019 European Association of Urology Terms and Conditions

Fig. 2 An 80-yr-old patient with GS 7 mCRPC treated with three cycles of 177Lu-PSMA for progressive disease. Prior treatments were sequenced as follows: docetaxel (six cycles), abiraterone, cabazitaxel (26 cycles), enzalutamide, rechallenge docetaxel (six cycles), carboplatinum, and denosumab. Left panels show the (A) PSMA and (B) FDG PET MIP prior to treatment and right panels demonstrate marked response on restaging scans 3 mo following completion of treatment. The corresponding PSA level was 441μg/l, which dropped to 33μg/l at the time of follow-up. (C) Response in bones. Top row: PSMA PET/CT and CT images at baseline show multiple highly PSMA-expressing osseous lesions. Bottom row: marked response following treatment. (D) Response in soft tissue. Top row: PET/CT and CT show highly PSMA-expressing soft tissue thickening in presacral region. Bottom row: significant response following treatment. CT=computed tomography; FDG=fludeoxyglucose; GS=Gleason score; mCRPC=metastatic castration-resistant prostate cancer; MIP=maximum intensity projection; PET=positron emission tomography; PSA=prostate-specific antigen; PSMA=prostate-specific membrane antigen. (Case courtesy of Peter MacCallum Cancer Centre, Melbourne, Australia.) European Urology Oncology DOI: (10.1016/j.euo.2019.01.001) Copyright © 2019 European Association of Urology Terms and Conditions