Dr. Juan Antonio Vallejo | GU Oncology Diagnostics

Join Dr. Juan Antonio Vallejo, Head of Nuclear Medicine at Reina Sofía University Hospital, Córdoba, Spain, as he explores recent advances in molecular imaging for genitourinary (GU) cancers. In this lecture, Dr. Vallejo highlights how tumor-targeted PET tracers are transforming diagnosis, patient management, and theranostic strategies in prostate, renal, and bladder cancers. Key topics covered: 1️⃣ Why Molecular Imaging in GU Oncology • Conventional imaging is anatomic-only; PET tracers provide biological phenotyping\ • Enables whole-body assessment and guides systemic therapy decisions • FDG PET limitations in prostate, renal, and bladder cancers 2️⃣ Prostate Cancer • PSMA PET: Highly specific, standard-of-care for biochemical recurrence and staging • Guides salvage therapy, lymphadenectomy, radiotherapy planning, and systemic therapy • Strong prognostic value; detection rates more than 50% for PSA less than 0.5 ng/mL • Theranostics: PSMA PET as a gatekeeper for radioligand therapy • SPARC project: Standardizing PSMA PET interpretation and reporting 3️⃣ Renal Cancer • FDG PET limited; emerging tracers provide higher specificity • CAIX PET (ZIRCON trial): Sensitivity ~86%, specificity ~89% • Reduces unnecessary biopsies, guides therapy decisions • Potential theranostic target with Lutetium‑177 or Actinium‑225 • FAPI PET: Visualizes tumor microenvironment; complements PSMA imaging 4️⃣ Bladder Cancer • FDG PET limited by urinary excretion • FAPI PET shows high tumor contrast • Nectin-4 PET: Predicts response to antibody-drug conjugates (e.g., Enfortumab Vedotin) • Opens opportunities for theranostic applications 5️⃣ Clinical Impact & Future Directions • Molecular imaging is not just diagnostic—it enables biology-driven management • Key challenges: regulatory approval, tracer availability, cost-effectiveness, multidisciplinary integration • Future: multi-tracer imaging, AI-driven radiomics, early response and resistance phenotyping • Combination strategies with systemic therapy are the next frontier