Novel technology of molecular radio-guidance for lymph node dissection in recurrent prostate cancer by PSMA-ligands
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Recently, prostate-specific membrane antigen-radioguided surgery (PSMA-RGS) has been introduced as a promising new and individual treatment concept in patients with localised recurrent prostate cancer (PC). In the following, we want to review our experience with PSMA-RGS in patients with localised biochemical recurrent PC.
A non-systematic review of the literature was carried out with focus on technical and logistical aspects of PSMA-RGS. Furthermore, published data on intraoperative detection of metastatic lesions compared to preoperative PSMA-PET and postoperative histopathology, postoperative complications as well as oncological follow-up data are summarized. Finally, relevant aspects on prerequisites for PSMA-RGS, patient selection, and the potential benefit of additional salvage radiotherapy or potential future applications of robotic PSMA-RGS with drop-in γ-probes are discussed.
First results show that PSMA-RGS is very sensitive and specific in tracking suspicious lesions intraoperatively. Prerequisite for patient selection and localisation of tumour recurrence is a positive Ga-HBED-CC PSMA positron-emission tomography (PET) scan with preferably only singular soft tissue or lymph node recurrence after primary treatment. Furthermore, PSMA-RGS has the potential to positively influence oncological outcome.
PSMA-RGS seems to be of high value in patients with localised PC recurrence for exact localisation and resection of oftentimes small metastatic lesions using intraoperative and ex vivo γ-probe measurements. However, patient identification on the basis of Ga-HBED-CC-PSMA PET imaging as well as clinical parameters is crucial to obtain satisfactory results.
KeywordsSalvage surgery Oligometastatic Prostate cancer PSA PSMA Radioguided surgery
I Rauscher: Protocol/project development, Data collection and management, Data analysis, Manuscript writing and editing. T Horn: Data collection and management, Data analysis, Manuscript writing and editing. M Eiber: Protocol/project development, Data analysis, Manuscript writing and editing. JE Gschwend: Protocol/project development, Manuscript writing and editing. T Maurer: Protocol/project development, Data collection and management, Data analysis, Manuscript writing and editing.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest or competing interests.
Research involving human participants
All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed written consent was obtained from all individual participants included in this study.
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