• Charles Sturt University nuclear medicine researcher embarks on a multi-national trial to improve prostate cancer outcomes for men in rural and remote Australia, and globally
• The trial confers Charles Sturt in an international leadership role in rural health research and could lead to cheaper and more accessible patient care
• The research trial project will recruit remote prostate cancer patients in the Kalgoorlie, Albany and Geraldton catchments in Western Australia

A leading Charles Sturt University nuclear medicine researcher is involved in a research trial that could deliver cheaper and more accessible prostate cancer diagnosis and treatment in rural and remote regions of Australia and around the world.

Professor in Nuclear Medicine Geoff Currie, AM, (pictured, inset) in the Charles Sturt School of Dentistry and Medical Sciences has joined clinical colleagues in Western Australia to lead a major prostate cancer research trial.

With colleagues at Telemed and Genesiscare, Professor Currie is running the Australian arm of a multi-national trial called the NOBLE (Nobody Left Behind) International Registry.

Professor Currie said the NOBLE research trial project has a specific rural and regional focus globally, and could change the prostate cancer treatment outcomes of many rural and remote men.

NOBLE is an initiative of an international consortium of clinicians including from Mexico, Nigeria, Turkey, South Africa, Egypt, India, and UAE which highlights the focus on developing health economies, and Australia.

The project is supported by the not-for-profit Oncidium Foundation and Telix Pharmaceuticals.

While Australia does not have a developing health economy, it does have a disparity in both opportunity and access to higher end health resources for our rural and remote communities.

Professor Currie said the clinical identification and treatment of prostate cancer is highly technical, as is the research.

“Prostate cancer (PC) is one of the most commonly diagnosed cancers overall and the most frequent cancer diagnosed in men,” he said.

“Early detection of primary disease and recurrence is crucial for patient management.

“Conventional imaging modalities such as computed tomography (CT) or magnetic resonance imaging (MRI) are limited because they focus on morphologic information such as lymph node size and tissue structure.”

The research will explore alternative technologies that have a specific rural and regional focus globally.

The trial aims to recruit remote prostate cancer patients in the Kalgoorlie, Albany and Geraldton catchments in Western Australia.

Professor Currie explained studies have consistently demonstrated prostate specific membrane antigen (PSMA) expression in all types of prostate tissue, and increased PSMA expression in cancer tissue.

“Due to PSMA’s significant over-expression on prostatic cancer cells, including advanced-stage prostate carcinomas, and its low expression in normal tissues, PSMA is considered ideal for developing small and low-molecular-weight targeted radiopharmaceuticals with fast blood clearance and low background activity,” he said.

“The procedure used extensively in the clinic for imaging of prostate cancer by PET/CT, including in Australia, has been the injection of Gallium (68Ga) PSMA-11.

“Unfortunately, PET/CT is not widely available, especially in low-income countries and in rural and remote Australia,” Professor Currie said.

He explained that gamma cameras are still the primary equipment used in many nuclear medicine centres in developing health economies, throughout New Zealand, and in many regional, rural and remote Australian communities.

Furthermore, access to the high-cost 68Ga generators and synthesis cartridges is prohibitive for many clinical sites with PET/CT available undertaking 68Ga PSMA-based imaging.

“A PSMA-targeting compound that could be used for gamma camera scintigraphy is highly clinically relevant as it could provide enormous patient benefit if it became readily available,” he said.

“Indeed, 99mTc based PSMA imaging would significantly improve inequities associated with social asymmetry in prostate cancer patients.

“Importantly, 99mTc-labeled tracers are significantly cheaper than PET/CT imaging agents, and therefore more accessible for many patients.

“For clinical sites without access to PET/CT, 99mTc has been labelled to PSMA successfully using HYNIC-iPSMA.

“This increases accessibility to PSMA theranostics for those in less developed health regions, avoiding the costs of PET/CT, cyclotrons or 68Ga generators.

“While more evaluation of 99mTc PSMA needs to be reported, clinical evidence using the product indicates it is very effective with high quality images.”

The NOBLE trial will:

1. Establish the safety and tolerability of patients during and following SPECT/CT administered with [99mTc]Tc-HYNIC-iPSMA.
2. Determine the clinical relevance of this diagnostic procedure ([99mTc]Tc-HYNIC-iPSMA SPECT) in detecting disease at different stages of prostate cancer in the setting where PET/CT lacks access (e.g. developing health economies internationally and, rural, regional and remote Australia).

The research aligns with the rural health research focus of Charles Sturt University and has Charles Sturt ethics approval.