“Theranostics” in the management of prostate cancer

The word “theranostics” is a so-called “portmanteau” word made up from the words “therapeutics” and “diagnostics“. Thus, “theranostics” refers to the process of “diagnostic therapy” for individual patients. What exactly do we mean by this?

With respect to prostate cancer, one of the most exciting examples of theranostics is in the area of nuclear medicine, where, by combining a potentially therapeutic agent like lutetium-177 with a diagnostic targeting agent like one of several forms of prostate-specific membrane antigen or PSMA, we can create “theranostic” agents that have the potential to (1) identify the presence of small amounts of prostate cancer that might be

  • Inside the prostate of a man who has already received first-line treatment with radiotherapy but whose PSA never rwally drops to a sufficiently low level after treatmement, or
  • In the prostate bed of a man treated by surgery but who has a rising PSA post-treatment, or
  • Outside the prostate in a man suspected of having micrometastatic prostate cancer

and then (2) use an appropriate dose of the therapeutic agent to actually treat the cancer.

We are really only at the very beginnings of the clinical application  of theranostics in the management of cancer in general and prostate cancer in particular.

For those who might have a deep interest in this topic. it is addressed in detail in a recent supplement to the Journal of Nuclear Medicine. All the reviews in this supplement appear to be available on line as full-text articles.

To quote one of the editors of this supplement (Wolfgang A. Weber, MD, chief of the Molecular Imaging and Therapy Service at Memorial Sloan-Kettering Cancer Center, New York):

Theranostics is the future of precision medicine. Therapies are not selected based on genetic mutations that may or may not be present in all cancer cells, but on imaging the whole patient and determining if a specific treatment can be effective. Because of the specific targeting of the cancer cells, theranostic agents are extremely well tolerated.

Now this particular opinion may reflect Dr. Weber’s personal enthusiasm for a field in which he is clearly deeply interested. It seems to us that the “future of precision medicine” is likely to be dependent on a number of different evolving capabilities, of which “theranostics” is just one (and identification of specific somatic and germline mutations is another). However, “theranostics” is certainly something we are going to hear more about in the not too distant future.

Here is a link to a nice slide presentation on the topic of theranostics originally developed by Prof. Peter Dobson, academic director of the Begbroke Science Park at Oxford, England (about 6 or 7 years ago). In other words, theranostics is by no means new in the world of translational medicine, but it is just starting to achieve its actual clinical potential.

One Response

  1. Thank you for bringing attention to this issue. It definitely is a promising field.

    Yours sincerely

    Finn Edler von Eyben

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