Prostate Cancer Imaging with 18F-Flotufolastat

Abstract

Medical imaging is often used to determine the staging of the cancer and if it is localized or if it has spread. Metastatic prostate cancer is the concern and the lower survival rate, if not detected. Nuclear medicine has played a pivotal role in prostate metastasis detection and treatment for many decades. The emergence of prostate-specific membrane antigen (PSMA)-targeted PET radiopharmaceuticals has significantly advanced the imaging of prostate cancer. Among these, ¹⁸F-flotufolastat, commercially known as Posluma, represents a pivotal development in the detection and management of PSMA-positive lesions. Its favorable pharmacokinetics-including low urinary excretion and minimal bladder activity-enhance lesion detectability in the pelvic region, a common challenge in prostate imaging. Clinical trials such as LIGHTHOUSE and SPOTLIGHT demonstrated ¹⁸F-flotufolastat's high specificity, diagnostic accuracy, and safety profile across diverse patient populations. With a cyclotron-produced ¹⁸F isotope and a 110-min half-life, ¹⁸F-flotufolastat offers logistical advantages for imaging centers and flexibility in scan timing. As a PSMA-based agent, ¹⁸F-flotufolastat enables precise visualization of prostate cancer cells and metastatic sites, positioning it as a valuable tool in the evolving landscape of nuclear medicine and prostate cancer care.

Keywords: 18F-flotufolastat; PSMA; clinical trials; metastases; prostate cancer; prostate-specific membrane antigen.