1.2 Analysis of Oncogenic Mechanisms from a Multidimensional Perspective
Table 1: Multiple Mechanisms of PSMA in Prostate Cancer Progression
| Mechanism | Key Signaling Pathway | Biological Effect | Clinical Significance |
|---|---|---|---|
| Metabolic Reprogramming | Glutamate-mTORC1 Pathway | Enhanced Energy Metabolism, Promotes Protein Synthesis | Provides Therapeutic Target |
| Angiogenesis | VEGF/VEGFR Signaling Axis | Increased Microvascular Density, Promotes Tumor Growth | Potential for Combination with Anti-Angiogenic Therapy |
| Survival Signals | PI3K-AKT Pathway | Enhanced Anti-Apoptotic Capability | Synergy with Targeted Drugs |
| Metastasis and Invasion | NF-κB-MMP Pathway | Promotes Cell Migration and Invasion | Associated with Metastatic Risk |
2 Clinical Translation of PSMA Imaging Techniques
2.1 Technical Optimization and Novel Tracers
PSMA PET/CT is a hybrid imaging modality that combines nuclear medicine and CT imaging, which has seen significant advancements in recent years. The "Chinese Expert Consensus on the Clinical Application of PSMA PET Imaging in Prostate Cancer," published in 2025, provides 22 standardized recommendations covering the entire process from initial diagnosis, staging, biochemical recurrence to treatment guidance.
In terms of technical optimization:
- Delayed scanning combined with long-axis field-of-view technology has increased the detection rate of lesions to 91%, significantly altering the treatment plans for 30-50% of patients.
- The accuracy of 68Ga-PSMA-11 PET/CT in staging high-risk prostate cancer at initial diagnosis has reached 92%.
- The diagnostic performance of 18F-DCFPyL PET/CT in lymph node staging improves with increasing prostate cancer risk, but early diagnosis remains challenging.
To address the challenge of early diagnosis in prostate cancer, Chinese researchers have recently optimized the automated synthesis process of [⁶⁸Ga]Ga-PSMA-D5, achieving preparation within 25 minutes, with a radiochemical purity greater than 99% and an activity yield of 70.8% ± 2.3% (non-decay corrected). [⁶⁸Ga]Ga-PSMA-D5 exhibits excellent tumor-to-background contrast, allowing clear visualization of small lesions and distant metastases.
