Optimising Patient Care in Prostate Cancer Treatment: A Joint Response on Dosimetry and Radiopharmaceuticals

The European Association of Urology (EAU) is proud to have a pivotal role in shaping prostate cancer treatment guidelines, particularly in the area of innovative therapies such as therapeutic radiopharmaceuticals (tRPs) or radioligand treatment (RLT) or "theranostics". A recent advancement in this area is the use of prostate-specific membrane antigen (PSMA)-targeted radioligands, which have shown promise in both diagnosing and treating prostate cancer. These therapies allow for precise delivery of radiation to patients with malignant tumours, leading to better survival rates and improved quality of life.

However, there are challenges regarding the accessibility and implementation of tRPs across Europe. The EAU, along with its partner organisations the European Association of Nuclear Medicine (EANM) and Europa Uomo (an organisation that focuses on raising awareness about prostate cancer care and advocating for better treatment for patients), has raised concerns about potential regulatory barriers that could limit the widespread use of tRPs. One key issue is the proposed requirement for systematic dosimetry (measuring the radiation dose during treatment). While dosimetry may offer benefits, there is currently no strong evidence to show that personalising treatment based on dosimetry improves cancer control or reduces side effects.

The EAU and its partners argue that mandatory dosimetry could complicate treatment, which would make it more resource-intensive and could also potentially limit patient access. They call for continued research into dosimetry to explore its benefits, but emphasise that any use of dosimetry should be based on solid clinical evidence that shows clear improvements in patient outcomes. The current European multidisciplinary guidelines on prostate cancer do not recommend dosimetry as a standard approach, due to the lack of conclusive evidence.

Professor Jochen Walz expressed his support: "I am very pleased to see this initiative between EANM, EuropaUomo, and EAU. Our joint statement highlights the challenges of requiring systematic dosimetry throughout the treatment process, which could limit access to radiopharmaceuticals for prostate cancer patients in the EU."

In conclusion, the EAU strongly supports the continued development and use of tRPs for prostate cancer. However, it needs to be stressed that any regulatory changes should be carefully considered to avoid restricting the access that a patient has to the treatment. The focus should remain on research that can provide the evidence needed to optimise treatment through personalised dosimetry. This would ultimately benefit patients by improving cancer control and reducing any side effects.