Dual-Tracer Selection for PSMA Radioligand Therapy

What this article is

This is a worked-example contributed article. It demonstrates the authorship-and-provenance system: a physician or scientist writes a focused synthesis of their area, names themselves in authors:, and lists the atlas pages their work informs:. The build then (1) shows the author and publication line at the top of this article, (2) lists the sections it informs at the bottom, (3) stamps a "Informed by contributed research" banner onto each of those atlas pages linking back here, and (4) aggregates this article onto the author's profile. The loop is bidirectional and fully derived — nothing is hand-maintained.

The clinical content below is real and referenced; the authorship is a template to be replaced.

The argument

PSMA radioligand therapy works only where the target is expressed. Selecting patients by PSMA PET alone misses the biology that most predicts failure: discordant disease — sites that are FDG-avid but PSMA-low — which behave aggressively and are not treated by a PSMA-directed radioligand. Pairing PSMA and FDG PET at selection identifies these mismatched patients before therapy rather than after progression.

The evidence that operationalized this is TheraP (ANZUP 1603), which screened patients with both ⁶⁸Ga-PSMA-11 and FDG PET, enrolling PSMA-avid disease and excluding PSMA-negative/FDG-positive disease. That dual-tracer gate — not just the head-to-head against cabazitaxel — is TheraP's most transferable contribution to practice: it turned the mismatch concept into a concrete selection rule. The pivotal survival evidence for ¹⁷⁷Lu-PSMA-617 comes from VISION, which established the overall-survival benefit in PSMA-positive mCRPC that makes correct selection worth the extra scan.

Why it matters for the atlas

A dual-tracer selection standard changes three things a reader should take away: PSMA PET is necessary but not sufficient for RLT selection; an FDG scan adds the negative-predictive information PSMA cannot; and "PSMA-positive" should be reported in a way that flags discordant sites, because those drive the decision to withhold or combine therapy.

How this maps into the atlas

This article's informs: list points at the pages whose content its argument supports — the TheraP trial page, the discordant PSMA/FDG pitfall page, the ¹⁷⁷Lu-PSMA-617 therapy page, and the PSMA-11 tracer page. Each of those now carries a provenance banner linking back here, so a reader on any of them can see the contributed reasoning behind the section and follow it to its author.