Theranostics a ‘State-of-the-Art’ Treatment Option for Prostate Cancer

For patients with prostate cancer, there are many treatment paths one can take — including theranostics.

Theranostics, a hybrid word that stems from therapy and diagnostics, is considered a “breakthrough precision medicine approach,” according to UCLA Health. This treatment type combines targeted imaging via positron emission tomography (PET) scans, which use radioactive tracers to form a 3-dimensional image of a person’s body tissues and organs to measure function, as the Mayo Clinic defines.

This treatment works by injecting the agent, which travels through a patient’s bloodstream to reach and target prostate cancer. After the injection, patients are scanned to see where the prostate cancer is located within the body, explained Dr. Jeffrey Wong during an interview with CURE®.

Wong is a radiation oncologist and professor in the Department of Radiation Oncology at the City of Hope in California.

However, for prostate cancer, “we want to know where the cancer is before making any kind of treatment decisions,” he noted. “For example, is it confined just to the prostate gland, or could it be elsewhere in the body? That will influence therapy.”

The Imaging Aspect of Theranostics for Prostate Cancer

Of note, imaging is one of the main aspects of theranostics for patients with prostate cancer, according to Wong. He emphasized that patients should also be aware of new PET imaging agents.

“There are nonstick PET imaging agents specifically for prostate cancer,” he explained. “They recognize something called PSMA, or prostate-specific membrane antigen, that is located on the surface of the prostate cancer tumor. It is the state-of-the-art and the best way to detect where prostate cancer deposits are within the body.”

Importantly, he mentioned that theranostics may be appropriate for patients who have some risk of having the disease outside of the prostate gland. Eligible patients could include those who were evaluated for radiation therapy, surgery or systemic therapy such as hormone therapy, known as androgen deprivation therapy (ADT), he said.

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Timewise, patients receive imaging dose as a single injection and undergo the scan the same day, Wong explained.

“For these particular agents, it’s an injection usually done as an outpatient and patients are then monitored, usually every couple of weeks or at least every month,” he said. “And then, the therapy is given every six weeks for a number of cycles, sometimes up to six cycles.”

Considering the Pros and Cons of Theranostics

For patients who have received many of the standard treatments for prostate cancer and are looking for other treatment options, Wong noted that there aren’t many cons to theranostics.

“These therapy agents are tolerated well and sometimes better than some chemotherapy agents,” he said. “The main side effects are temporary blood count depression, meaning their blood counts can come down — not as much as with certain chemotherapy agents — but can come down and usually do not require transfusions.”

He explained that patients who experience side effects are typically managed as outpatients and their blood counts eventually return to where they started.

“[Decreased blood counts are] the main temporary side effect,” Wong said. “Could there be long-term side effects that are yet to be identified? That's a possibility, but that's a possibility with all the cancer therapies, whether it's standard of care or newly FDA approved, I think that patients should just primarily be aware that the temporary the main side effect is a temporary decrease in the blood count.

“Some patients may have a little fatigue with the treatments that may be associated with the decrease in blood count, but again, that's the primary side effect to focus on.”

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