Bridging the Molecular Imaging Gap: How 99mTc-iPSMA SPECT is Democratizing Prostate Cancer Care
By Prof Geoff Currie, AM | BPharm, MMedRadSc(NucMed), MAppMngt(Hlth), MBA, PhD | Professor in Nuclear Medicine, School of Dentistry and Medical Sciences, Charles Sturt University, Wagga Wagga, Australia | Professor in Radiology (Adjunct) | Baylor College of Medicine, Houston, USA
In the fast-evolving world of medical imaging, technological progress is often measured in scan resolution, detection accuracy, and tracer sensitivity. But sometimes, its real measure lies in impact, especially for patients in the shadows of geographic or socioeconomic inaccessibility. Our recent work trialling 99mTc-HYNIC-iPSMA SPECT imaging in rural Australia (and more broadly through the global NOBLE registry) highlights how innovation applied to existing technologies can profoundly improve health equity.
Positron emission tomography/computed tomography (PET/CT) has rightly earned its place as a gold-standard tool for prostate cancer detection and staging. PSMA-based PET imaging is revolutionising care, offering unmatched accuracy and opening doors to radioligand treatments like 177Lu-PSMA. But access is a luxury not shared by all.
In Medicine, we often equate new with better. But sometimes, better comes from using what we already have, but better.
In Australia, vast distances and a decentralised population structure leave rural and remote patients at a stark disadvantage. The nearest PET scanner is hundreds of kilometers away for a large number of them. Factor in socioeconomic barriers and Indigenous health disparities, and the situation becomes one not only of inconvenience but of inequity. The reality is starker globally. In many low- and middle-income countries, PET/CT remains virtually inaccessible. SPECT, on the other hand, is ubiquitous.
Instead of constructing expensive PET centers in every underserviced area, our group looked into a different approach: utilizing PSMA imaging’s capabilities with the existing SPECT infrastructure. Our tracer of choice, 99mTc-HYNIC-iPSMA, is a technetium-labeled PSMA inhibitor, developed by Australian company Telix, with promising affinity and biodistribution, and compatible with conventional gamma cameras.
The Australian arm of the NOBLE trial focused on 27 patients in some of the most isolated regions of Western Australia; Kalgoorlie, Geraldton, and Albany. We used 99mTc-iPSMA to successfully perform high-quality SPECT imaging in spite of the logistical difficulties associated with fly-in-fly-out nuclear medicine services. The results were compelling:
- Lesions were detected in 81.5% of patients.
- No adverse events were reported.
- In 41% of cases, the scan led to a change in patient management.
Globally, similar outcomes were observed. The management change rate in our intermediate report from the NOBLE registry, which included patients from Egypt, South Africa, Mexico, Indonesia, and Azerbaijan, was 42.5%; once more, no safety issues were found.
For these patients, the difference between SPECT and PET is not merely one of scan quality. It’s the difference between receiving targeted care and none at all. The affordability and logistical simplicity of 99mTc-iPSMA imaging means:
- More rural patients can access molecular imaging without the need for travel.
- More clinicians can accurately stage disease and make informed treatment decisions.
- More healthcare systems can provide precision medicine within resource constraints.
Just as importantly, technetium-based tracers can be paired with generator-produced therapeutic isotopes like 188Re, creating a theranostic pathway for patients outside the larger metropolitan centres.
Of course, change never comes without friction. PET has a brand and a standard that clinicians trust. Convincing referring physicians of the value of PSMA SPECT means investing in education, quality assurance, and validation. There’s also a need for robust health economic modelling to support reimbursement, especially in publicly funded systems.
But the payoff could be substantial. The infrastructure exists. The tracer is safe and effective. And the opportunity to extend the benefits of molecular imaging to Australia and the world’s underserved populations is within reach.
If healthcare innovation is to mean more than just cutting-edge gadgets, it must embrace solutions that lift care standards everywhere. Indeed, the price tag attached to most innovations and advances limits accessibility to those already privileged. 99mTc-iPSMA isn’t just a workaround; it’s a legitimate tool to extend access, enhance care, and bridge inequities in cancer diagnosis and management. Its value lies not in replacing PET/CT, but in complementing it, serving those for whom PET is out of reach.
In Medicine, we often equate new with better. But sometimes, better comes from using what we already have, but better.
References
Currie, G. et al. (2025). Prostate cancer detection with 99mTc-iPSMA SPECT: the Australian experience. Radiography. https://doi.org/10.1016/j.radi.2025.103003
Tually, P. et al. (2024). Real world experience with [99mTc]Tc-HYNIC-iPSMA SPECT prostate cancer detection: interim results from the global NOBLE registry. EJNMMI Reports, 8:43. https://doi.org/10.1186/s41824-024-00226-4