Theranostics of Primary Prostate Cancer: Beyond PSMA and GRP-R

Simple Summary The accurate assessment of the aggressiveness and localization of primary prostate cancer lesions are essential for treatment decision making. Around 15% of lesions are missed by PSMA Positron-Emission tomography/computed Tomography (PET/CT). The aim of our study was to investigate the potential of novel surface markers to detect PSMA-negative lesions using immunohistochemistry and autoradiography techniques. Our work demonstrates that targeting both PSMA and neurotensin receptors might detect all intra-prostatic lesions. This new finding has implications for the future theranostics of primary prostate cancer. The imaging of Prostate-Specific Membrane Antigen (PSMA) is now widely used at the initial staging of prostate cancers in patients with a high metastatic risk. However, its ability to detect low-grade tumor lesions is not optimal. Methods: First, we prospectively performed neurotensin receptor-1 (NTS1) IHC in a series of patients receiving both [Ga-68]Ga-PSMA-617 and [Ga-68]Ga-RM2 before prostatectomy. In this series, PSMA and GRP-R IHC were also available (n = 16). Next, we aimed at confirming the PSMA/GRP-R/NTS1 expression profile by retrospective autoradiography (n = 46) using a specific radiopharmaceuticals study and also aimed to decipher the expression of less-investigated targets such as NTS2, SST2 and CXCR4. Results: In the IHC study, all samples with negative PSMA staining (two patients with ISUP 2 and one with ISUP 3) were strongly positive for NTS1 staining. No samples were negative for all three stains-for PSMA, GRP-R or NTS1. In the autoradiography study, binding of [In-111]In-PSMA-617 was high in all ISUP groups. However, some samples did not bind or bound weakly to [In-111]In-PSMA-617 (9%). In these cases, binding of [(111)n]In-JMV 6659 and [In-111]In-JMV 7488 towards NTS1 and NTS2 was high. Conclusions: Targeting PSMA and NTS1/NTS2 could allow for the detection of all intraprostatic lesions.

Automated summary

The accurate assessment of primary prostate cancer lesions is crucial for treatment decision making. PSMA Positron-Emission tomography/computed Tomography (PET/CT) may miss around 15% of lesions. Our study reveals that targeting both PSMA and neurotensin receptors could detect all intraprostatic lesions, which has implications for future theranostics of primary prostate cancer.