Prostate-specific membrane antigen (PSMA) as a potential target for molecular imaging and treatment in bone and soft tissue sarcomas

Br J Radiol. 2023 Apr 1;96(1145):20220886. doi: 10.1259/bjr.20220886. Epub 2023 Mar 3.

Abstract

Bone and soft tissue sarcomas are a group of rare malignant tumours with major histological and anatomical varieties. In a metastatic setting, sarcomas have a poor prognosis due to limited response rates to chemotherapy. Radioligand therapy targeting prostate-specific membrane antigen (PSMA) may offer a new perspective. PSMA is a type II transmembrane glycoprotein which is present in all prostatic tissue and overexpressed in prostate cancer. Despite the name, PSMA is not prostate-specific. PSMA expression is also found in a multitude of non-prostatic diseases including a subgroup of sarcomas, mostly in its neovascular endothelial cells. On PET/CT imaging, multiple sarcomas have also shown intense PSMA-tracer accumulation. PSMA expression and PSMA-tracer uptake seem to be highest in patients with aggressive and advanced sarcomas, who are also in highest need of new therapeutic options. Although these results provide a good rationale for the future use of PSMA-targeted radioligand therapy in a selection of sarcoma patients, more research is needed to gain insight into optimal patient selection methods, PSMA-targeting antibodies and tracers, administered doses of radioligand therapy, and their efficacy and tolerability. In this review, mRNA expression of the FOLH1 gene which encodes PSMA, PSMA immunohistochemistry, PSMA-targeted imaging and PSMA-targeted therapy in sarcomas will be discussed.

Publication types

  • Review

MeSH terms

  • Endothelial Cells / metabolism
  • Endothelial Cells / pathology
  • Humans
  • Male
  • Molecular Imaging
  • Positron Emission Tomography Computed Tomography / methods
  • Prostate-Specific Antigen / metabolism
  • Prostatic Neoplasms* / diagnostic imaging
  • Prostatic Neoplasms* / radiotherapy
  • Sarcoma* / diagnostic imaging
  • Sarcoma* / radiotherapy

Substances

  • Prostate-Specific Antigen