PSMA-PET guided hook-wire localization of nodal metastases in prostate cancer: a targeted approach

  • Emma Clarebrough
  • Catriona DuncanEmail author
  • Daniel Christidis
  • Alain Lavoipierre
  • Nathan Lawrentschuk
Invited Review


Prostate Specific Membrane Antigen Positron Emission Tomography/Computed Tomography (PSMA-PET/CT) has increased the sensitivity and specificity of imaging to identify metastatic prostate cancer in the group of patients with early biochemical recurrence when compared to conventional imaging. In patients who develop biochemical recurrence of prostate cancer following surgical resection, salvage lymph node dissection may reduce prostate specific antigen (PSA) levels and delay the time for commencement of systemic therapies. However, PLND may be an anatomically and technically difficult procedure, particularly with small metastatic diseases which can be problematic for intra-operative identification. We describe the technique using PSMA-PET imaging to pre-operatively localise areas of low-volume nodal metastatic disease with hookwire to allow targeted lymph node dissection with direct visualisation and palpation to ensure adequate clearance of involved nodes.


Image guided surgery Hookwire Prostate cancer Pelvic lymph node dissection PET-PSMA scan Lymph node metastasis 



Biochemical recurrence


Computed tomography


Lymph node dissection


Positron emission tomography


Prostate specific antigen


Prostate specific membrane antigen


Author contributions

E Clarebrough: Manuscript writing/editing, D Cristidis: Data collection or management, Manuscript writing/editing, C Duncan: Manuscript writing/editing, A Lavoipierre: Protocol/project development, Data collection or management, N Lawrentschuk: Protocol/project development, Data collection or management

Compliance with ethical standards

Conflict of interest

All of the authors declare that they have no conflict of interest.

Informed consent

The individual re-identifiable data included in this article were included with the informed consent of the patient.

Human and animal rights

This article does not contain any experimental studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryRoyal Melbourne HospitalParkville, MelbourneAustralia
  2. 2.Young Urology Research Organisation (YURO)MelbourneAustralia
  3. 3.Department of UrologyAustin HealthHeidelberg, MelbourneAustralia
  4. 4.Epworth Medical Imagig, Epworth Freemasons Hospital MelbourneMelbourneAustralia
  5. 5.Department of SurgeryUniversity of MelbourneMelbourneAustralia
  6. 6.Olivia Newton-John Cancer Research InstituteHeidelberg, MelbourneAustralia
  7. 7.Department of Surgical OncologyPeter MacCallum Cancer CentreMelbourneAustralia

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