Radiomics and theranostics with molecular and metabolic probes in prostate cancer: toward a personalized approach.

In the last decade, two new radionuclide-based therapies, ²²³Radichloride and radioligand therapy (RLT) targeting prostate-specific membrane antigen (PSMA), have been approved by the regulatory authorities for the management of castrate-resistant prostate cancer (PCa). The basic principles of PCa molecular imaging are illustrated, with a particular attention to the combined use of diagnosis and therapy in a unique approach (the so-called theranostics) for response prediction and assessment in patients submitted to ²²³Radichloride or PSMA targeted therapies. In this perspective, the potential of radiomics, an emerging discipline based on the extraction of quantitative features from medical images, is covered. Theranostic metabolic and molecular probes have been successfully applied to predict and monitor response to radionuclide-based therapies. In particular, both ^99mTc-MDP and ¹⁸F-NaF resulted useful tools for personalized dosimetry and prognostic stratification before ²²³Ra-therapy, while PSMA-ligands, alone or in combination with ¹⁸F-FDG, provided valuable information to select patients who are more likely to benefit from RLT and getting information on PCa grade of differentiation and aggressiveness. In spite of its high potential, PET-radiomics for PCa is still at an embryonic phase and needs further validation. [ABSTRACT FROM AUTHOR]