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For patients with prostate cancer, there are many 

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.

Managing Long-Term Side Effects in Prostate Cancer ‘Really Important’

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.”

For more news on cancer updates, research and education, don’t forget to 

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For patients with prostate cancer, theranostics may be another available treatment path to take, especially for those who need more options. 

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

At the 2024 ESMO Congress, an expert explained how Nubeqa may reduce fatigue-related side effects in metastatic hormone-sensitive prostate cancer.

Therapies for Some With Prostate Cancer Focuses on Reducing Side Effects

Newer treatments for metastatic hormone-sensitive prostate cancer like Nubeqa (darolutamide) are being developed to potentially reduce side effects like cognitive impairment and fatigue, an expert said.

CURE® sat down with Dr. Fred Saad, director of prostate cancer research at Montreal Cancer Institute and full professor in the department of surgery at the Université de Montréal, on-site at the 

 to learn more about what Nubeqa is and how it may differ from other available treatment options for metastatic hormone-sensitive prostate cancer.

At the meeting, Saad presented findings from the phase 3 ARANOTE trial, which included patients with metastatic hormone-sensitive prostate cancer. Saad and his colleagues aimed to assess the efficacy and safety of Nubeqa plus androgen-deprivation therapy (hormone therapy to reduce testosterone levels) compared with placebo plus androgen-deprivation therapy.

Findings from the trial demonstrated that Nubeqa plus androgen-deprivation therapy significantly improved radiological progression-free survival (PFS; time patients live without their disease worsening or spreading) versus placebo plus androgen-deprivation therapy. This benefit was also seen in patients with high- and low-volume metastatic hormone-sensitive prostate cancer. Treatment with Nubeqa plus androgen-deprivation therapy was associated with a low incidence of treatment-emergent side effects, with a lower rate of treatment discontinuations from treatment-emergent side effects when adding Nubeqa (6.1% versus 9%).

[Nubeqa] is an androgen receptor inhibitor, which has a distinct molecular structure compared to apalutamide (Erleada) and enzalutamide (Xtandi) that are already established in the field.

What we developed with this medication is to try to have as little penetration of the drug into the brain to try to reduce the risks of cognitive impairment, fatigue and other issues. And also address the issue in the minority of patients who might be at risk of seizures. So this drug seems to be safe in patients even at risk of seizures. And all the trials using [Nubeqa] did not exclude patients with a seizure history or at risk of seizures.

Radiopharmaceuticals, defined by the National Cancer Institute as drugs that contain radioactive substances, are at the forefront of treating patients with prostate cancer, as one radiation oncologist explained in an interview with CURE®.

“The newest addition to the arsenal of treatments that we can use is Pluvicto [(lutetium Lu 177 vipivotide tetraxetan, also known as 177Lu-PSMA-617],” said Dr. Malay S. Rao, a radiation oncologist with Cooperman Barnabas Medical Center in Livingston, New Jersey.

was approved by the Food and Drug Administration in 2022

 to treat patients with PSMA-positive metastatic castration- resistant prostate cancer, including those previously treated with other therapies including androgen receptor pathway inhibitors and taxane-based chemotherapy.

Rao spoke with CURE® about how drugs such as Pluvicto work. He also discussed treatments via hypofractionated radiation therapy and what the most important factor is for newly diagnosed patients with prostate cancer to consider.

®: How does a drug like Pluvicto work to treat prostate cancer?

: Pluvicto is a medicine that is injected into your blood. Depending on the type of equipment [the treatment center] has, it can take anywhere from one minute up to 30 minutes to infuse the medicine. The way the medicine works is there are these cell surface receptors that we call PSMA, standing for prostate-specific membrane antigens, and Pluvicto latches on to those cell surfaces, which typically are found more so on prostate cancer cells than any other cells in your body.

So, we exploit that mechanism where we're trying to target the medicine to just seek out the prostate cancer cells — unlike chemotherapy, which really targets all rapidly dividing cells in your body [and] that could include your hair, the lining in your gut, the Pluvicto's specific for that membrane receptor. Once it latches, it gets internalized into the cell, once internalized, it releases a small radioactive molecule or atom, which then deposits the radioactive dose, thereby killing that cancer cell.

I would imagine that because of this highly targeted approach, the overall impact on a patient’s quality of life is very different than it would be from previous standards of care.

You're right, given that it has a very targeted mechanism. These types of medicines are a much newer category with a different mechanism of action than the conventional chemotherapy agents. And I think, increasingly, we probably will see more use of this technology in the future application as we come up with more products driven to target different cancers, not just prostate.

Another topic I'd like to discuss is a hypofractionated radiation therapy. What is that and how is that used to treat prostate cancer?

Hypofractionated radiation therapy, the term itself means doing less fractions, meaning the number of treatments. Conventionally speaking, for decades now we've been doing prostate external beam radiation, for anywhere from about an eight- to nine-week course; 44 to 45 treatments has been the standard. The newer approach has been looking to see if we can do the same regimen quicker, faster, with fewer visits, yet maintain safety and maintain the same level of cure rates.

And, multiple studies have been done in North America, Europe, and they've all come to the same conclusion that yes, we can do what we did over nine weeks and cut it down to something as short as five to six weeks, thereby reducing health care costs, improving patient convenience and yet maintaining safety and efficacy.

For newly diagnosed patients with prostate cancer, what should they know in general about the array of radiation treatments that are currently available to them?

For newly diagnosed prostate cancer, the most important thing to consider is, is your cancer low risk, intermediate risk or high risk? We start by putting your cancer into one of these buckets, because that really narrows down our treatment options. And unlike most other cancers, what's unique here is low-risk prostate cancer can be further subdivided into very low risk, also. And sometimes the intermediate cancers can be divided into favorable or unfavorable.

And that distinction is important because often for low-risk prostate cancers, and depending on your age, favorable-risk intermediate prostate cancers, can be followed with active surveillance, which typically involves checking your PSA [prostate-specific antigen, a protein associated with the presence of prostate cancer in the body] with a blood test twice a year, maybe repeating the biopsy and/or MRI at the one year anniversary from your previous biopsy date.

So there's a lot of vetting we do to make sure you meet these criteria for active surveillance. The advantage of active surveillance being that it avoids the treatment-related side effects. It helps you maintain your sex life or your intimacy, if that's still an important factor in your quality of life. And many times, depending on the person in front of you, maybe that's high priority and they're not willing to forego that as a treatment side effect that often comes whether surgery or radiation, [patients] can develop permanent erectile dysfunction. That's the first thing that needs to be looked at. There's often staging studies that also accompany this diagnosis.

And last but not least, there's something called a genomic fingerprint of your cancer, which is really being utilized more and more frequently for prostate cancer. And it really analyzes the tissue specimen from your biopsy. And we send it to a lab, which then sequences your tumor's genomic sequencing, look for high-risk genes and then gives us the score, which we try to interpret as, "Is the fingerprint of your cancer low, indolent, slow growing, or do you harbor more aggressive genes that make your cancer aggressive?" So that's also another piece we've been incorporating into the decision making.

Transcript has been edited for clarity and conciseness.

From radiopharmaceuticals to hypofractionated radiation therapy, one expert explained the current landscape of radiation treatments for prostate cancer.

What Patients Should Know About Radiation Treatment for Prostate Cancer

Intensity-modulated radiation therapy (IMRT) — which is a common radiation strategy for men with prostate cancer — has changed and improved over the last two decades. The treatment is now more precise than ever, according to a review published in Translational Andrology and Urology.

This therapy can help doctors carefully avoid radiating organs near the prostate.

CURE® recently spoke with Dr. Arun Goel, site chief of genitourinary radiation oncology at the Perelman Center for Advanced Medicine at the University of Pennsylvania about what IMRT is, what it means for patients, what they can expect before receiving this treatment and more.

CURE®: What is IMRT and what does it mean for patients with prostate cancer?

: [IMRT] generally refers to an advanced form of photon-based radiation therapy. If you look at IMRT plans, we typically result in very high doses of radiation to the prostate, while minimizing dose to organs like the bladder, rectum, bowel or even the bony structures.

Generally, the total dose is delivered across five to nine weeks in small daily doses. There's something called 3D conformal radiation therapy. We basically use a computed tomography (CT; a machine that captures detailed images of the areas in the body) scan to get a three-dimensional model of the target the organs that are around the target, in this case, the prostate.

That information is then used to shape three or four radiation beams to cover the tumor. When using that approach, we get great coverage of the prostate, but you also would get a more-than-necessary dose to other organs. That technique is still used for a variety of cancers because generally, with those types of cancers, we give lower dose of radiation. With prostate cancer, we have to give higher doses of radiation to actually achieve cure. So what IMRT does is it really takes precision to the next level. It divides the radiation beams into smaller beamlets, or even arcs, in which the radiation is delivered as the machine rotates around the patient. The intensity of the beam varies depending on the angle the beam or position in the ark and that allows us to sculpt the dose around adjacent organs.

For patients who have been told that they are going to receive IMRT, what can they expect?

It'll vary from place to place. In certain practices, there may be a small outpatient procedure where some markers are placed into the prostate both markers, or a rectal spacer or gel, which is an instrument that pushes the prostate away from the rectum, allowing the [clinicians] to reduce rectal dose.

Afterwards, there's something called a simulation or a planning scan. Essentially, it's basically just a CAT scan, maybe an MRI. And patients are generally given some sort of preparation leading up to it. It may be just to increase your hydration, there may be a bowel preparation— probably less so than you do for a colonoscopy — but some sort of prep just to empty the bowels before you come in. The CAT scan is performed of the patient in the treatment position, which may involve the patient having to keep a full bladder for a short amount of time. This is generally performed by a set of radiation therapists under the guidance of a physician.

At simulation, patients may also get some small pinpoint tattoos. And after that, there's usually some downtime as the plans are being generated. The next time, they may show up maybe one to two weeks later to start their daily treatments.

What are some side effects patients may experience after IMRT?

Side effects generally involve some short-term fatigue or changes in urinary or bowel functions. Inflammation of the bladder and inflammation of the urethra can lead to increase urinary frequency, some urinary urgency, a weakening of the urinary stream or even some burning with urination. Inflammation of the rectal wall can lead to diarrhea or pain when defecating.

It's important to say that these side effects are generally in the mild category and temporary, meaning that they can be managed with either lifestyle modifications, pretty routine over the counter prescription medications and they should resolve within eight to 12 weeks after radiation therapy is completed. 

Initial Quality of Life Decreases After Radiation in Prostate Cancer

It's also important to remember that experiences are going to vary from patient to patient. For a small number of patients, these bothersome urinary or bowel complaints, or side effects that require management with medications actually can become persistent or rise episodically over the course of many years. Generally, that number is going to be around 10%. More major side effects with radiation therapy are pretty rare.

Sexual side effects can also be challenging to tease out. A lot of studies are going to include a wide variety of men, different ages, different baseline sexual function. Generally, there's no immediate impact on sexual function with radiation therapy, but it may

accelerate an actual age-related decline. So, when we look at men who have good sexual function at baseline, meaning that they're able to successfully have sex and 50% of them will still be able to at five years. There can be some variability if there's use of hormone therapy, which is probably out of scope for this but certainly something that's worth talking to physicians about.

This transcription was edited for clarity and conciseness.

For more news on cancer updates, research and education, don’t forget to 

With smaller radiation beams, intensity-modulated radiation therapy “takes precision to the next level” for patients with prostate, an expert told CURE®.

IMRT ‘Takes Precision to the Next Level’ in Prostate Cancer Radiation

As racial disparities persist regarding prostate cancer, relationships between patients and providers, as well as patient education and self-care, can be crucial factors in improving outcomes, experts said.

Black men are 60% more likely than White men to receive a diagnosis of prostate cancer in their lifetime, and more than twice as likely to die from prostate cancer than White men, noted Dr. Daniel J. George, Eleanor Easley Distinguished Professor in the School of Medicine at Duke University.

“There's a biological reason that this disease is happening more frequently and progressing more aggressively, and then there's also a social access construct that's affecting how they're cared for that also influences their outcomes,” said George.

George was the co-author of a literature review published in 2022 in the journal 

 which analyzed data regarding racial disparities in prostate cancer.

“Racial disparities observed among Black men with [prostate cancer] are multifaceted, evolving from institutional racism,” George and his colleagues wrote. “Cultural factors include generalized mistrust of the health care system, poor physician-patient communication, lack of information on [prostate cancer] and treatment options, fear of [prostate cancer] diagnosis, and perceived societal stigma of the disease. In the United States, geographic trends in racial disparities have been observed. Economic factors, e.g., cost of care, recovery time and cancer debt, play an important role in racial disparities observed in [prostate cancer] treatment and outcomes.”

Acknowledging that “there is a historical perspective to just be sensitive to for Black men and women in this country that have historically been underserved by our systems for decades,” George stressed the importance of patient/provider relationships — something which his research noted “must be improved.”

“Trust is something that we're all very familiar with in life, and it comes with experience … but with medicine, sometimes we don't have that luxury,” said George. “Patients present with disease that needs to be treated — sometimes with pretty radical treatment — right from the start. For people to put their faith into the person or the system that is going to perform that radical therapy, there 

. So, building that is so critical, and recognizing that there is a divide by our cultural races that we have to be at least cognizant of and intentional in addressing, the sensitivity around [that], is really important.”

Despite persistent obstacles and disparities, George noted that there is still “a lot that’s in our control,” starting with lifestyle choices for patients.

“Prostate cancer is a chronic disease, so recognizing the other health strategies that will absolutely affect your treatment outcome, both in terms of your tolerance of treatment, your response to treatment, and your long-term recovery from treatment. It's really important for you to understand what you can modify, to maximize your outcome, to get the best result you can have,” George said. “Those are things like your exercise, your diet, your sleep. We tend to ignore that, but they’re really important aspects.”

“Having regimens associated with your lifestyle … is so important because the treatments we give will modify your motivation. It'll be harder to diet and exercise and sleep. Because the treatments are going to interfere with those things, having a structure and regimen that make them consistent will help you push against those changes that therapy is likely to cause. … It's not simply prescribing a drug or doing a surgery or radiation, it's helping patients manage themselves and in own their health care as much as we do with them.”

Patients, George said, can also empower themselves with knowledge of their disease.

“The power to understand what is happening to your body gives you the ability to manage that and manage that psychologically, but also physically,” he said. “So, understanding your particular cancer … because it's different from the people you may know who have had prostate cancer, every case is not identical, and so recognizing and understanding where you fall in that continuum is really important.”

“Education is key for patients,” said Dr. Hiba Khan, a medical oncologist and assistant professor in the clinical research division of the Fred Hutchinson Cancer Center in Seattle. “There are lots of resources out there for patients to educate themselves about not only their risk for prostate cancer but once they are diagnosed with prostate cancer, different treatment modalities that are available, different tests that they could get that could further inform risk and treatment options.”

Resources, Khan said, are available via organizations such as the American Cancer Society and ZERO Prostate Cancer. Patients, once educated, should feel comfortable and open to speaking with their providers about what they’re learning and continue to advocate for themselves.

Patient/provider trust, education and lifestyle choices are crucial as Black men face higher incidence and mortality in prostate cancer, experts said.

Prostate Cancer

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