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In a new study involving nearly 600 biopsy-naïve men, researchers found that only 4 percent of those with negative prostate MRI had clinically significant prostate cancer after three years of active monitoring.

Study Reaffirms Low Risk for csPCa with Biopsy Omission After Negative Prostate MRI

The use of an adjunctive machine learning model led to 17 and 21 percent improvements in the AUC and sensitivity rate, respectively, for PET/MRI in diagnosing extraprostatic tumor extension in patients with primary prostate cancer.

Can AI Enhance PET/MRI Assessment for Extraprostatic Tumor Extension in Patients with PCa?

In a new point-counterpoint discussion published in the American Journal of Roentgenology, researchers debate the merits and limitations of the Prostate Imaging Reporting and Data System (PI-RADS) version 2.1.

Is PI-RADS Version 2.1 Outdated for Prostate MRI?

Researchers found that new prostate lesion detection on SPECT/CT at the beginning of a second cycle of 177 Lu-PSMA-617 for mCRPC was associated with an over sevenfold higher mortality risk.

What SPECT/CT May Reveal About Early Treatment Response for Pluvicto in Patients with mCRPC

Employing deep learning reconstruction at four excitations for DWI MRI may lead to an average five-minute reduction in exam time for prostate mpMRI, according to a new study.

Can Deep Learning Reduce DWI MRI Exam Time Without Affecting Prostate Image Quality?

The positron emission tomography (PET) agent 18F-flotufolastat detected has a nearly 75 percent detection rate for recurrent prostate cancer in patients with prostate-specific antigen (PSA) levels of less than 1 ng/mL, according to research presented at the American Society for Radiation Oncology (ASTRO) conference.

In a recent interview, Bridget Koontz, M.D., the lead author of the post-hoc analysis from the SPOTLIGHT trial, said delayed renal clearance with 18F-flotufolastat (Posluma, Blue Earth Diagnostics) provides a unique advantage in this patient population in comparison to other imaging agents.

“Excretion into the bladder is slower (with 

F-flotufolastat) than some of the other agents out there … so you don't get sort of a cloud of urinary uptake that can blur … when we're trying to see what's happening in the prostate or in the prostate bed. That is a big advantage for low PSA patients, because they're less likely to have metastatic disease and, frankly, more likely in the post prostatectomy space to have prostate bed recurrence,” emphasized Dr. Koontz, the medical director of radiation oncology at AdventHealth Cancer Institute in Orlando, Fla.

(Editor’s note: For related content, see “

F-Flotufolastat PET Imaging Changes Treatment in 89 Percent of Patients with Prostate Cancer Recurrence

Recurrent Prostate Cancer and Low PSA Levels: Can an Emerging PSMA PET Agent Have an Impact?

Optimal Timing and Frequency of Imaging Agents Used in the Detection and Characterization of Oligometastatic Prostate Cancer

In addition to an overall 69 percent detection rate in those with a pSA level of less than 1 ng/mL, the researchers found a 74 percent detection rate of PCa recurrence in patients with PSA levels between 0.5 ng/mL 

F-flotufolastat maintained high detection rates with even lower PSA levels, noting a 67 percent rate in those with PSA levels 0.3 ng/mL 

0.5 ng/mL and a 68 percent rate when PSA levels were 0.2 ng/mL 

(Editor's note: For additional content on prostate cancer imaging, visit 

For more insights from Dr. Koontz, watch the video below.

1. Koontz BF, Lowentritt B, Jani AB, et al. 

F-flotufolastat detection rates in the pelvis region for patients with prostate cancer recurrence after radical prostatectomy and PSA levels < 1 ng/mL: data from the phase 3 SPOTLIGHT study. Presented at the American Society for Radiation Oncology (ASTRO) 2024 Annual Meeting, September 29-October 2, 2024. Available at: 

https://www.astro.org/meetings-and-education/micro-sites/2024/annual-meeting

Bridget Koontz, MD discusses recent research at the ASTRO conference that shows benefits of the PET agent 18F-flotufolastat for detecting PCa recurrence in patients with low PSA levels.

Can 18F-Floutufolastat Bolster Detection of PCa Recurrence in Patients with Low PSA Levels After Radical Prostatectomy?

In a recent interview, Bridget Koontz, M.D., discussed the capability of the PET imaging agent 18F-flotufolastat for diagnosing post-prostatectomy recurrence of prostate cancer in patients with PSA values less than 1 ng/mL, based on research presented at the American Society for Radiation Oncology (ASTRO) conference.

Can 18F-Flotufolastat Bolster Detection of PCa Recurrence in Patients with Low PSA Levels After Radical Prostatectomy?

For African Americans with suspected prostate cancer (PCa) recurrence, the PET imaging agent 

F-flotufolastat (Posluma) provided a 93 percent patient-level detection rate (DR) that was six percent higher than that reported for other patients in the recent SPOTLIGHT trial.

F-flotufolastat had a 67 percent DR for African American patients with a prostate-specific antigen (PSA) level < 0.5 ng/mL and a 100 percent DR for those with a PSA level > 10 ng/mL in this patient population, according to the post-hoc analysis of the SPOTLIGHT trial that was recently published in 

In a recent interview, Soroush Rais-Bahrami, M.D., the lead author of the study, noted some small differences in regional detection rates between African Americans and other patients but said the findings were largely similar otherwise for the use of Posluma (Blue Earth Diagnostics) in diagnosing 

“The findings holding true and being validated in large part both with imaging and histopathologic confirmation really make this new FDA-approved PSMA PET imaging agent valid in all populations of men, specifically African Americans as well as non-African American men included in the study,” maintained Dr. Rais-Bahrami, a professor in the Departments of Urology and Radiology at the University of Alabama School of Medicine in Birmingham, Ala.

Dr. Rais-Bahrami also noted that African American men comprised 17 percent of the SPOTLIGHT study cohort, nearly double the rate of African American participation reported in oncology clinical trials from 2010 to 2021.

“This shows promise that clinical trials, specifically in the realm of cancer, can have a good diversity of enrollment in terms of subjects. One of the real elements of our focus in terms of performing clinical trials should be sure to encourage not only diversity of race … but also different areas regionally throughout the country and internationally as well as different sites of practice to really reach patients with different points of access, socioeconomic status, race, ethnicity and cultural factors that may play a large role in their overall medical and specifically, in this case, cancer care,” emphasized Dr. Rais-Bahrami.

Emerging Research at SNMMI Examines 18F-Flotufolastat in Managing Primary and Recurrent Prostate Cancer

Can Targeted PSMA PET/CT Guided Radiotherapy Have an Impact for Oligometastatic Prostate Cancer?

Study: PSMA PET/CT More Advantageous than MRI for Locoregional Staging of Prostate Cancer

For more insights from Dr. Rais-Bahrami, watch the video below.

Soroush Rais-Bahrami, M.D., discusses a recent study that examined the use of 18F-flotufolastat (Posluma) for detecting prostate cancer recurrence in African American men.

Detecting PCa Recurrence in African Americans: Can 18F-Flotufolastat Have an Impact?

In a recent interview, Soroush Rais-Bahrami, M.D., discussed key findings from a post-hoc subgroup analysis of the SPOTLIGHT trial that examined the use of the PET imaging agent 18F-flotufolastat (Posluma) in African American men.

In separate studies presented at the recent 

, the positron emission tomography (PET) radiotracer 

F-flotufolastat demonstrated no urinary retention in patients with primary prostate cancer (PCa) and facilitated a 15 percent higher percentage of biochemical failure-free survival in comparison to conventional imaging for guided salvage radiotherapy in patients with recurrent PCa.

In one study comparing 18F-flotufolastat (Posluma, Blue Earth Diagnostics) and 

, researchers found that 18 percent of primary tumors located near the bladder in the 

Ga-PSMA-11-PET group (3/17) were obscured by radioactivity in the bladder in comparison no obscured tumors with 

F-flotufolastat (0/24). The study authors also reported a 27.4 percent rate of halo artifacts with the 

Ga-PSMA-11-PET cohort (17/62) in contrast to 4.8 percent (3/62) for those in the 

The researchers also emphasized that there was no ureter retention with 

F-flotufolastat in comparison to 21 percent (13/62) for men in the 

David Gauden, D.Phil, discussed these study results during an interview at the SNMMI conference.

“Their findings were clinically impactful in their opinion in that they had a much lower background radioactivity in the bladder (with 

F-flotufolastat) when they were evaluating the scans. (This) gave them more confidence in their diagnostic findings when they evaluated it on a multi-point scale of background (radiopharmaceutical) activity, leading them to believe that when you’re looking for local recurrences, using an agent with this lower bladder excretion could be clinically valuable in helping with the management of these patients,” noted Gauden, the chief executive officer for Blue Earth Diagnostics.

Study: 18F-Flotufolastat PET Imaging Changes Treatment in 89 Percent of Patients with Prostate Cancer Recurrence

Could Pluvicto Have a Role in Taxane-Naïve mCRPC?: an Interview with Oliver Sartor, MD

SNMMI: PSMA-18F DCFPyL Changes Treatment for PCa Recurrence in Significant Number of Patients with Low PSAs

In a separate study of 110 patients with biochemical recurrence of PCa after radical prostatectomy, researchers compared 

F-flotufolastat PET-guided salvage radiotherapy (SRT) to conventional SRT. Although the researchers conceded a lack of statistical significance, they found that the 

F-flotufolastat PET-guided group had 8 percent, 15 percent, and 21 percent higher rates of biochemical failure-free survival at one, two and three years, respectively, than those who had conventional SRT.

“Although it was a small study without a statistically significant finding, there were trends toward longer biochemical progression-free survival for the group where the radiotherapy was guided by PET imaging in addition to the standard field … ,” added Gauden.

For more insights from Mr. Gauden, watch the video below.

David Gsuden, D.Phil, discusses new research, presented at the SNMMI meeting, that examines use of 18F-flotufolastat in patients with prostate cancer.

Emerging Research at SNMMI Examines 18F-flotufolastat in Managing Primary and Recurrent Prostate Cancer

1. Rauscher I, Langbein T, Fuetterer CS, Weber W, Eiber M. Evaluation of qualitative and quantitative PET parameters in primary prostate cancer patients: double-match comparison of 18F-flotufolastat and 68Ga-PSMA-11-PET. Presented at the 2024 Society of Nuclear Medicine and Molecular Imaging Annual Meeting, June 8-11, Toronto, Canada. Available at: 

https://www.xcdsystem.com/snmmi/program/10OD8Tq/index.cfm

2. Rauscher I, Vogel MME, Gschwend J, Peeken JC, Eiber M. 18F-rhPSMA-7 and 18F-flotufolastat PET-guided salvage radiotherapy in recurrent prostate cancer. Presented at the 2024 Society of Nuclear Medicine and Molecular Imaging Annual Meeting, June 8-11, Toronto, Canada. Available at: 

In a recent interview at the SNMMI conference, David Gauden, D.Phil, discussed key findings from new research evaluating the use of the PET radiotracer 18F-flotufolastat in patients with primary prostate cancer (PCa) and men with biochemical recurrence of PCa. 

The radiopharmaceutical agent (177Lu)Lu-PSMA-617 (Pluvicto, Novartis) may be a viable option in the treatment of patients with taxane-naïve metastatic castration-resistant prostate cancer (mCRPC), according to emerging research findings presented at the 2024 Society of Nuclear Medicine and Molecular Imaging (SNMMI) Annual Meeting.

, Oliver Sartor, MD, said there are reimbursement challenges as well as mixed results with current androgen receptor pathway inhibitor (ARPI) treatment in this patient population.

“We know (ARPI therapy) is a viable alternative, but we also know these patients will progress and go on to need additional therapy,” noted Dr. Sartor, the director of radiopharmaceutical trials at the Mayo Clinic in Rochester, Minnesota.

In new research, which garnered Abstract of the Year honors at the SNMMI conference, researchers compared the use of Pluvicto versus a change in ARPI therapy (abiraterone or enzalutamide) in 468 taxane-naïve patients with mCRPC.

In the primary study analysis, the researchers found that patients in the Pluvicto group had a significantly higher median radiographic progression-free survival in comparison to those in the ARPI change group (9.3 months vs. 5.55 months). A second interim analysis revealed that patients in the Pluvicto group had over a 35 percent higher objective response rate (50.7 percent vs. 14.9 percent) and a significantly longer median time to PSA progression (10.55 months vs. 4.24 months) in contrast to patients in the ARPI change cohort.

Dr. Sartor, a co-author of the study, also noted that the second interim analysis showed a lower incidence of grade > 3 adverse events in patients receiving Pluvicto.

Emerging Perspectives on PSMA PET Radiotracers: An Interview with Kenneth J. Pienta, MD

Study: PSMA PET/CT Agent May Rule Out csPCa in 93 Percent of PI-RADS 3 Lesions

While Pluvicto was approved by the FDA for patients with PSMA-positive mRCPC who previously had ARPI therapy and taxane-based chemotherapy, Dr. Sartor suggested there is “reasonable hope” for an expanded indication for Pluvicto in the management of patients with taxane-naïve mRCPC.

“If the FDA does give an approval, it will truly be practice-changing, Insurances will cover it and patients can be treated,” added Dr. Sartor.

For more insights from Dr. Sartor, watch the video below.

Oliver Sartor, MD, discusses the potential of Pluvicto in treating metastatic castration-resistant prostate cancer in taxane-naive patients.. 

Could Pluvicto Have a Role in Taxane-Naïve mCRPC?: An Interview with Oliver Sartor, MD 

In an interview at the SNMMI 2024 conference, Oliver Sartor, M.D. discussed key findings from new award-winning research evaluating the potential of Pluvicto in treating patients with taxane-naïve metastatic castration-resistant prostate cancer (mCRPC).

Could Pluvicto Have a Role in Taxane-Naive mCRPC?: an Interview with Oliver Sartor, MD

Overtreatment of patients with prostate cancer has been a significant issue and may have impacted between one to two million men with the disease, suggested Steven Raman, M.D., in a recent interview.

However, the emergence of magnetic resonance imaging (MRI)-guided transurethral ultrasound ablation (TULSA) appears to be a promising option for men with intermediate risk 

, a treatment that has a more favorable side effect profile than surgery and radiation, according to Dr. Raman, a professor of radiology, urology and surgery at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA).

In research presented at the recent Society of Interventional Radiology (SIR) conference, Dr. Raman noted the use of MRI-guided TULSA led to a 92 percent reduction in median prostate volume (from 37.3 ml to 2.8 ml) and a 48 percent reduction in the presence of Gleason Grade (GG) 2 PCa at one year.

At five years after treatment with MRI-guided TULSA, Dr. Raman and colleagues found that 87 percent of patients had preserved erectile function and 92 percent had recovered pad-free continence.

Dr. Raman says the use of MRI guidance and thermometry are more advantageous than prior ultrasound monitoring of thermal ultrasound treatments and key to the success of the TULSA procedure.

“What I don’t like about (ultrasound monitoring) is you don’t know how hot (it is) getting and where exactly you are treating. With MRI, thermometry is an important tool. MRI images the entire prostate as you’re treating it and while you’re treating it, you’re seeing how hot things get in the prostate and outside the prostate,” explained Dr. Raman. “This is an important safety tool to minimize damage to the nerve, the sphincter, and other things, and that results in much better outcomes.”

Emerging Insights on MRI-Guided Transurethral Ultrasound Ablation for Prostate Cancer

Can MRI-Guided Transurethral Ultrasound Ablation Have an Impact for Localized Prostate Cancer?

Can MRI Findings Help Predict Toxicity After Radiotherapy for Prostate Cancer?

For more insights from Dr. Raman, watch the video below.

In a recent interview, Steven Raman, M.D., discussed MRI-guided transurethral ultrasound (TULSA) in the treatment of intermediate risk prostate cancer. 

A Closer Look at MRI-Guided Transurethral Ultrasound Ablation for Intermediate Risk Prostate Cancer

In a recent interview, Steven Raman, M.D., discussed the use of MRI-guided transurethral ultrasound (TULSA) in the treatment of intermediate risk prostate cancer and key research findings with one- and five-year outcomes. 

Artificial intelligence (AI) is of course one of, if not the hottest topic at this year's 

, but how is all of the hype translating to clinical practice?

As exciting as new technology can be, actually using that technology requires a great deal of effort, especially for larger institutions that are faced with training dozens of radiology staff. 

User education is a key component to adoption and uptake, according to Nina Kottler, MD, MS, associate chief medical officer of clinical artificial intelligence at Radiology Partners. Dr. Kottler spoke with 

 at RSNA 2023, where she reflected on Radiology Partners hitting (and recently surpassing) an impressive milestone: utilizing clinical AI in more than 20 million patient exams. None of that would be possible without purposeful training programs to make sure that radiology end-users are comfortable with the new technology and understand the key benefits of use. 

Dr. Kottler, who is also an associate fellow at Stanford University's Center for Artificial Intelligence in Medicine & Imaging (AIMI), also spoke about what she has observed in terms of the affect that AI is having on radiology workflows. 

Watch the interview below for additional insights on AI. 

Nina Kottler, MD, MS, of Radiology Partners, discusses the importance of user education to improve uptake of AI technology and improve ROI. 

Nina Kottler, MD, MS on AI Adoption in Radiology

Click here for more coverage of RSNA 2023.

Dr. Kottler sat down with Diagnostic Imaging at RSNA 2023 to discuss AI imaging milestones and the potential impact of AI on workflows in radiology. 

Nina Kottler, MD, MS on Adoption and Impact of AI in Radiology

This content originally appeared on our sister site, 

Prostate cancer imaging is having its moment in the spotlight, with numerous advances in imaging agents for positron emission tomography slated to help improve diagnostics in a disease that's rife with recurrence. 

The most recent news comes from Blue Earth Diagnostics, whose radioactive imaging agent Posluma (flotufolastat F 18) was 

 for positron emission tomography (PET) of prostate-specific membrane antigen (PSMA) positive lesions in men with prostate cancer with suspected metastasis who are candidates for initial definitive therapy or those with suspected recurrence based on elevated serum prostate-specific antigen (PSA) level.

While improved imaging will certainly move the needle on diagnosis, it's yet to be seen how this will ultimately impact patient outcomes. 

, Brian F. Chapin, M.D., associate professor of urology at the University of Texas MD Anderson Cancer Center in Houston, spoke about the potential impact of PSMA PET and some of the challenges the clinical community is facing in the wake of these advances. 

Click here for more of the latest research on prostate imaging

The approval of Blue Earth Diagnostics' Posluma (flotufolastat F 18) is a significant step forward for PSMA PET imaging, but will it actually help improve patient outcomes?

Brian F. Chapin, M.D. on the Uptake of PSMA PET in Prostate Imaging

Approximately 40 to 50 percent of men will have prostate cancer recurrence over a 15 to 20-year period but the sensitivity in pinpointing locations of recurrence remains a significant limitation for conventional imaging such as computed tomography (CT), bone scans and magnetic resonance imaging (MRI), noted Brian Helfand, M.D., in a recent interview from the American Urological Association’s (AUA) 2023 Annual Meeting in Chicago.

“The success of conventional imaging is directly associated with the level of PSA (prostate-specific antigen). The higher the PSA, the more likely the conventional imaging can detect those sites of recurrence. But in general, the PSA has to be greater than 10 or 20 (ng/mL) for those modalities to pick up those sites of recurrence,” said Dr. Helfand, chief of the Division of Urology for the NorthShore University HealthSystem, and a clinical professor at the University of Chicago.

F-rhPSMA-7.3 (Blue Earth Diagnostics/Bracco Imaging) may have promising utility for the diagnosis of prostate cancer recurrence in patients with lower PSA levels. In a subgroup analysis of 389 patients from the phase 3 SPOTLIGHT study who had been treated with primary radiation therapy, Dr. Helfand and colleagues found that out of 76 patients diagnosed with prostate cancer recurrence (with a median baseline PSA of 4.4 ng/mL), 

F-rhPSMA-7.3 had a detection rate of 76 percent for recurrence in the prostate bed and detected recurrence in distant extra-pelvic sites in 43 percent of patients.

Could a New PSMA PET Agent Improve Detection of Distant Metastatic Lesions in Patients with Prostate Cancer?

Is PSMA PET/CT More Beneficial than Bone Scintigraphy in Detecting Bone Lesions in Cases of High-Risk Prostate Cancer?

“The whole point of this scan is that it allows, at lower PSA levels, to detect where that (prostate recurrence) site is and helps us come up with a subsequent therapy that is most effective in those patients,” noted Dr. Helfand, who presented the research at the AUA conference. “It’s always a surprise when you have distant metastases … When that happens, that can definitely change how we think about treatment and the type of the treatment that patient will get.”

For more insights from Dr. Helfand, watch the video below.

In a recent video interview from the American Urological Association (AUA) 2023 Annual Meeting, Brian Helfand, M.D., discussed emerging research that shows the potential viability of the agent F18-rhPSMA-7.3 for enhancing the detection of prostate cancer recurrence and facilitating earlier intervention for patients with low prostate-specific antigen (PSA) levels.

Can an Emerging PSMA/PET Agent Improve Detection of Prostate Cancer Recurrence in Patients with Low PSAs?

Conventional imaging can be limited in the detection of metastatic lesions associated with prostate cancer. Specificity rates for computed tomography (CT) are “reportedly all over the map,” ranging from 40 to 60 percent, pointed out Brian Chapin, MD, in a video interview from the recent American Society of Clinical Oncology Genitourinary Cancers (ASCO GU) symposium.

“When there is lymph node involvement … , the lymph nodes themselves can be small and the deposits within those lymph nodes can be as small as 1 to 3 mm in size sometimes so it’s really hard to identify those with a conventional imaging approach,” explained Dr. Chapin, an associate professor, director of clinical research and fellowship program director in the Department of Urology within the Division of Surgery at the University of Texas MD Anderson Cancer Center in Houston.

However, in recent research presented at the ASCO GU symposium, Dr. Chapin and colleagues found the use of the radiopharmaceutical agent 18F-rhPSMA-7.3 (Blue Earth Diagnostics/Bracco Imaging) with positron emission tomography (PET) led to verified detection of distant metastatic lesions in 10 to 15 percent of 335 patients with newly diagnosed intermediate or high-risk prostate cancer.

“One in 10 patients that we had planned to bring to the operating room with presumed localized prostate cancer indeed had metastatic disease, which is quite substantial, especially when you’re looking at a population of men who had (negative conventional imaging with CT, MRI and bone scan),” emphasized Dr. Chapin. “Those were all negative and you’re identifying metastatic disease in one in 10 patients. That is pretty substantial because that can change our clinical decision-making in how we treat patients.”

Study Assesses PET Agent for Detecting Pelvic Lymph Node Metastases in Patients with Prostate Cancer

Could an Emerging PSMA/PET Imaging Agent Improve the Detection of Recurrent Prostate Cancer?

In a video interview from the recent American Society of Clinical Oncology Genitourinary Cancers (ASCO GU) Symposium, Brian Chapin, MD, discussed emerging research that demonstrated the ability of the positron emission tomography (PET) agent 18F-rhPSMA-7.3 to diagnose distant M1 lesions prior to surgery for patients with intermediate to high-risk prostate cancer.

Disease Spotlight: Prostate Cancer

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