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99mTc-PSMA targeted robot-assisted radioguided surgery during radical prostatectomy and extended lymph node dissection of prostate cancer patients

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Abstract

Objective

The feasibility of tracer production of 99mtechnetium (Tc)-prostate-specific membrane antigen (PSMA)—I&S sterile cold kit, imaging with single photon emission tomography/computed tomography (SPECT/CT), and 99mTc-PSMA-radioguided robot-assisted laparoscopic radical prostatectomy (99mTc-PSMA-RG-RALRP) technique for lymph node (LN) dissection of primary prostate cancer (PCa) patients were evaluated prospectively.

Methods

Fifteen primary PCa patients with intermediate- or high-risk score according to D’Amico risk stratification who had PSMA receptor affinity with Ga-68 PSMA-11 PET/CT were enrolled. After 99mTc-PSMA-I&S injection and SPECT/CT imaging, 99mTc-PSMA-RG-RALRP with DaVinci XI robotic platform and laparoscopic gamma probe were performed. Radioactive rating of resected tissue was compared with post-operative histopathology. Physiological and pathological uptakes of organs and tissues for both imaging modalities were compared.

Results

Physiological radiotracer distribution was similar for both imaging modalities. PCa lesions were much more visible on PET/CT. Metastatic LNs could not be visualized with SPECT/CT. Eighteen of 297 totally dissected LNs were metastatic, which were exactly the same with per-operative probe counts with sensitivity, specificity, accuracy, and negative and positive predictive value of all 100%. The median follow-up was 23.5 ± 4.6 months. tPSA reduction was > 98%. The 2.5 years biochemical recurrence-free survival, PCa-specific treatment-free survival and overall survival rates were 86,7%, 66,7% and 100%, respectively.

Conclusion

Tc-99 m-PSMA-RG-RALRP is a promising technique for extended pelvic lymph node dissection (ePLND) during robotic surgery, which may shorten the operation time and reduce complication risks. If LN metastases is detected during surgery with PSMA-targeted probe, it may be an early indicator of PCa-spesific treatment planning. Tc-99 m-PSMA-I&S SPECT/CT is not as successful as Ga-68 PSMA-11 PET/CT for diagnosis of primary PCA lesions or LN metastases.

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Acknowledgements

Health Sciences University Turkey, Scientific Research Project (2018/076). We would like to thank medical physicist Özlem EREZ for her contribution to the preparation of Tc-99m-PSMA-I&S.

Funding

Health Sciences University Turkey, Scientific Research Project (2018 / 076).

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Authors and Affiliations

  1. Health Sciences University, Basaksehir Cam and Sakura City Hospital, Clinic of Nuclear Medicine, Başakşehir Mahallesi G-434 Caddesi No: 2L, Başakşehir, Istanbul, Turkey

    Burçak Yılmaz

  2. Health Sciences University, Bakırkoy Dr. Sadi Konuk Research and Training Hospital, Clinic of Urology, Istanbul, Turkey

    Selçuk Şahin & Ali İhsan Taşçı

  3. Health Sciences University, Istanbul Research and Training Hospital, Clinic of Nuclear Medicine, Istanbul, Turkey

    Nurhan Ergül & Tevfik Fikret Çermik

  4. Health Sciences University, Basaksehir Cam and Sakura City Hospital, Clinic of Urology, Istanbul, Turkey

    Yunus Çolakoğlu

  5. Health Sciences University, Bakırkoy Dr. Sadi Konuk Research and Training Hospital, Clinic of Pathology, Istanbul, Turkey

    Halil Fırat Baytekin

  6. Urology Department, Memorial Hospital, Istanbul, Turkey

    Doğukan Sökmen & Volkan Tuğcu

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  1. Burçak Yılmaz
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  2. Selçuk Şahin
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Yılmaz, B., Şahin, S., Ergül, N. et al. 99mTc-PSMA targeted robot-assisted radioguided surgery during radical prostatectomy and extended lymph node dissection of prostate cancer patients. Ann Nucl Med 36, 597–609 (2022). https://doi.org/10.1007/s12149-022-01741-9

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