艾昆纬-放射配体治疗是新加坡癌症治疗的未来（英）-2025_26页_3mb

Overview of Prostate Cancer and RLT in Singapore

• Prostate cancer (PC) is the most common malignancy in Singapore males, projected to reach 18,000 cases by 2040.
• Radioligand therapy (RLT), particularly Lu-177 PSMA-targeted agents, offers superior progression-free survival (PFS) and quality of life (QoL) for metastatic castration-resistant prostate cancer (mCRPC).
• Current RLT capacity (0.6 NMs/100k population) is insufficient to meet demand (350-400 patients by 2040), with delays in diagnosis and treatment.

Systemic Challenges

1. Stakeholder Awareness & Education
   • Limited awareness among broader medical community and patients; urologists and oncologists are generally informed but lack cross-disciplinary knowledge.
   • Diagnostic gaps: Non-RLT prescribers have lower PSMA-PET testing rates (25-57% vs. 83-100% for RLT prescribers).
2. Infrastructure & Workforce
   • Low NM specialist concentration (20/38 active RLT providers); occupancy rates in public hospitals constrain capacity.
   • Insufficient workforce training; radiation exposure is within safe limits but future demands may strain systems.
3. Regulatory & Access Barriers
   • RLT operates under a broad nuclear medicine framework, lacking a dedicated regulatory pathway.
   • High out-of-pocket costs; MediShield Life and MediSave partially cover costs but do not fully address financial barriers.
4. Research & Diversification
   • Research focuses on PC and neuroendocrine tumors (NETs); limited exploration of other cancer indications.
   • Need for real-world evidence to support long-term efficacy and safety across diverse patient groups.

International Experiences

• Canada’s British Columbia: Invested CAD 32M in nuclear medicine infrastructure and research.
• EU Guidelines: Standardized clinical frameworks for PSMA RLT eligibility and treatment protocols.
• Ontario, Canada: Publicly funded RLT via government reimbursement, ensuring equitable access.

Call to Action & Recommendations

1. Increase Awareness: Host seminars for HCPs and patients; develop clear referral pathways.
2. Expand Infrastructure: Establish RLT centers; upgrade diagnostic tools (PSMA-PET).
3. Develop Regulatory Framework: Create RLT-specific guidelines for safety, quality, and accessibility.
4. Enhance Funding: Explore innovative financing models (e.g., means-tested support, outcome-based payments).
5. Strengthen Workforce: Integrate RLT training into medical education; allocate incentives for NM specialists.
6. Promote Research: Diversify RLT trials beyond PC; collaborate with global institutions for real-world data collection.

Conclusion
Singapore has the potential to position itself as a leader in precision oncology by addressing gaps in awareness, infrastructure, regulation, and funding through strategic collaboration and policy adaptation.