Thomas Hope, MD, an associate professor of radiology and director of Molecular Therapy for the Molecular Imaging and Therapeutics Clinical Section of the Department of Radiology and Biomedical Imaging at the University of California, San Francisco (UCSF), discusses the clinical impact of using 68Ga-PSMA-11 PET to detect pelvic nodal metastasis in men with intermediate- or high-risk prostate cancer.

, positive findings from a prospective phase 3 clinical trial demonstrated utility of the radiotracer 68Ga-PSMA-11 in this setting. Moreover, the results led to the submission of a new drug application to the FDA, Hope says. 

Pending approval, the availability of the PSMA PET may alleviate some challenges in initial staging of these patients, explains Hope.

Clinically, a majority of men who have positive nodes after prostatectomy still experience biochemical recurrence, says Hope. Historically, it has been known that the presence of positive nodes is a main predictor of recurrence. However, with the use of the PSMA PET, this information can potentially be available prior to surgery, adds Hope.

The question of how to best utilize that information to optimize outcomes for patients with positive nodes prior to prostatectomy remains unanswered, concludes Hope. 

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Thomas Hope, MD, discusses the clinical impact of using 68Ga-PSMA-11 PET to detect pelvic nodal metastasis in men with intermediate- or high-risk prostate cancer.


Dr. Hope on the Impact of Using 68Ga-PSMA-11 to Detect Pelvic Nodal Metastasis in Prostate Cancer

Thomas Hope, MD, an associate professor of radiology and director of Molecular Therapy for the Molecular Imaging and Therapeutics Clinical Section, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), discusses the rationale for using 68Ga-PSMA-11 PET to detect pelvic nodal metastasis in men with intermediate- or high-risk prostate cancer.

A prospective phase 3 trial evaluated the sensitivity and specificity of the radiotracer 68Ga-PSMA-11 in detecting pelvic nodal metastases at the time of radical prostatectomy in men with intermediate- or high-risk prostate cancer. 

Previously published data from Europe demonstrated the utility of Ga68-PSMA-11 in this setting, says Hope.

Positive findings from this study support the utility of this radiotracer, as well as the submission of a New Drug Application to the FDA, concludes Hope.

Thomas Hope, MD, discusses the rationale for using 68Ga-PSMA-11 PET to detect pelvic nodal metastasis in men with intermediate- or high-risk prostate cancer.



Dr. Hope on Using 68Ga-PSMA-11 to Detect Pelvic Nodal Metastasis in Prostate Cancer

Thomas Hope, MD, an associate professor of radiology at University of California, San Francisco (UCSF), discusses considerations when making sequencing decisions for patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs).

There is no answer to the optimal sequence of treatments for patients with GEP-NETs, because there are no data to support an order to the available treatments, explains Hope. The decision regarding what therapy to give a patient depends on their disease and comorbidities, including liver failure, renal failure, bone marrow injury, diabetes, infections, and more, according to Hope.

Additionally, the location of the disease impacts whether patients should receive liver-directed therapy or surgical resection. Hope suggests physicians consider the patient, extent of disease, type of tumor, aggressiveness of tumor, and tumor grade when deciding what therapy to administer.

The decision how to sequence therapy for each patient often falls to multidisciplinary tumor boards, says Hope. At UCSF, the tumor boards involve radiology, nuclear medicine, medical oncology, surgery, and pathology, concludes Hope.

Thomas Hope, MD, discusses considerations when making sequencing decisions for patients with gastroenteropancreatic neuroendocrine tumors.

Dr. Hope on Sequencing Considerations for GEP-NETs

Thomas Hope, MD, an associate professor of radiology at University of California, San Francisco, discusses treatment options for patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs).

Treatment strategies for patients with GEP-NETs are typically split into 2 categories: small bowel NETs and pancreatic NETs. The treatment methodology for patients is based on the primary origin of the tumor.

Patients with small bowel NETs will typically receive treatment with somatostatin analogs. After progression, patients may consider peptide receptor radionuclide therapy (PRRT) or everolimus (Afinitor), depending on the pace and extent of disease.

Pancreatic NETs have a higher Ki-67 score and patients may, depending on the aggressiveness and extent of tumor presentation, start with capecitabine (Xeloda) plus temozolomide or a somatostatin analog. Other approved therapies to treat patients with pancreatic NETs include sunitinib (Sutent), everolimus, or PRRT.

The sequencing of treatments for both diseases is unclear. Other treatment options include surgery and liver-directed therapy. However, with multiple options and an unclear sequencing strategy, the choice is complex, concludes Hope.

Thomas Hope, MD, discusses treatment options for patients with gastroenteropancreatic neuroendocrine tumors.

Dr. Hope on Treatment Options for GEP-NETs

Thomas Hope, MD, assistant professor of abdominal imaging and nuclear medicine at University of California, San Francisco (UCSF), discusses the future of imaging for biochemical recurrent prostate cancer.

Hope says that it is important to understand how novel imaging techniques such as PSMA-PET effect care by including them in clinical trials, as well as demonstrating when they should be used.

Dr. Hope on the Future of Imaging for Biochemical Recurrent Prostate Cancer

Thomas Hope, MD, assistant professor, UCSF Helen Diller Family Comprehensive Cancer Center, discusses imaging for patients with neuroendocrine tumors (NETs).

Imaging of NETs is difficult because they grow slowly over time and conventional PET imaging, using glucose or FDG-PET scan, has low-detection sensitivity, explains Hope.

There have recently been PET scans that use somatostatin receptor-targeted agents, most notably being DOTATOC and DOTATATE PET imaging, which are labeled with Gallium-68. These imaging modalities have demonstrated much higher sensitivity for the detection and characterization of NETs, states Hope.

Dr. Hope on Imaging for Neuroendocrine Tumors

Thomas Hope, MD, assistant professor, UCSF Helen Diller Family Comprehensive Cancer Center, discusses the Gallium 68-Dotatate PET scan in the imaging of neuroendocrine tumors (NETs).

Imaging for NETs is difficult as they are slow growing, requiring very sensitive imaging studies. Commonly, the octreoscan has been used in practice to track these tumors, which targets somatostatin receptors.

Recently, the Gallium-68 dotatate scan that is labeled with Gallium-68, a radionuclide, has demonstrated much higher sensitivity for both detection and characterization of NETs.

While the cost is high, the benefits outweigh this, says Hope. Octreoscan takes a minimum 1 2 days to complete, while a Gallium-68 dotatate scan takes about 1 hour to conduct after injection. Also, the improved imaging allows physicians to more accurately track patients over time.

Thomas Hope, MD

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