Prostate cancer theranostics In the last six years, Australian researchers have led the application of radiolabelled prostate specific membrane antigen (PSMA), which is transforming the clinical landscape of prostate cancer management. This transmembrane glycoprotein is highly expressed in the majority of prostate cancer cells, providing a molecular target for diagnostic and therapeutic applications. A 10-site Australian multicentre, randomised study, the ProPSMA Trial, was published in The Lancet (April, 2020) demonstrating that Gallium-68 (⁶⁸Ga)-PSMA PET/CT has superior diagnostic accuracy to conventional CT and whole body bone scan for staging men with newly diagnosed high-risk prostate cancer.

The network established for the ProPSMA trial led directly to another randomised trial in men with metastatic castration-resistant prostate cancer, called TheraP, comparing Lutetium-177 (¹⁷⁷Lu)-PSMA theranostics to care cabazitaxel chemotherapy in 200 men with progressive metastatic castration resistant prostate cancer. The study results were presented at the world’s pre-eminent oncology conference ASCO20 and demonstrated a higher response rate and lower toxicity in the men receiving radionuclide therapy. These practice-changing results are paving the way for PSMA PET/CT and PSMA therapy to become a new standard-of-care option for men with prostate cancer.

Establishing a Centre of Excellence To accelerate research and development, the Prostate Theranostics and Imaging Centre of Excellence (ProsTIC) has recently been established at the Peter MacCallum Cancer Centre. ProsTIC comprises a multidisciplinary team led by nuclear medicine physician Professor Michael Hofman and includes nuclear medicine, medical oncology, radiation oncology, urology and laboratory-based doctors and researchers with a strong patient-centered philosophy. Excitingly, nuclear medicine is at the core of this multidisciplinary team.

Dr Nattakorn Dhiantravan, an early career nuclear medicine physician, is the proud recipient of the RACP Arnott Research Entry Scholarship in Cancer Research. This is enabling him to undertake a PhD investigating the role of ¹⁷⁷Lu-PSMA as a first-line rather than a last-line of therapy. He is running two clinical trials, one comparing the addition ¹⁷⁷Lu-PSMA to docetaxel chemotherapy in men with newly diagnosed metastatic prostate cancer, and another examining the therapeutic activity of this novel agent in a neoadjuvant setting prior to radical prostatectomy. Dr Dhiantravan is also focusing on the discovery of novel molecular imaging biomarkers in prostate cancer, through integration of artificial intelligence applications. “This scholarship, together with grant funding from Movember, is enabling me to pursue a combined clinical and research career. My daily work involves a balance between clinical, imaging diagnostic and research responsibilities as well as close collaboration with colleagues from medical oncology, urology, radiation oncology, radiochemistry, medical physics and imaging technology teams. Nuclear medicine has offered me an ideal environment and opportunity to grow as a physician and incorporate new and exciting discoveries into my daily practice,” said Dr Dhiantravan.