Skip to main content
SpringerLink
Log in

„PSMA-radioguided surgery“ beim lokal begrenzten Prostatakarzinomrezidiv

Aktueller Stand und zukünftige Entwicklungen

PSMA-radioguided surgery in localized recurrent prostate cancer

Current and future aspects

  • Leitthema
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Kürzlich wurde die „PSMA-radioguided-surgery“ (PSMA-RGS) zur gezielten Resektion beim lokalisierten Prostatakarzinomrezidiv eingeführt. Indiziert wird die PSMA-RGS durch eine 68Ga-PSMA-Positronen-Emissions-Tomographie (‑PET), die möglichst nur ein singuläres Weichteil- oder Lymphknotenrezidiv zeigt. Bei entsprechender Indikation wird nach Injektion von 111In-PSMA-I&T oder 99mTc-PSMA-I&S bei den Patienten routinemäßig eine Single-Photonenemissionscomputertomographie (SPECT)/Computertomographie (CT-)Untersuchung durchgeführt, um eine adäquate Radionuklidaufnahme in den Tumorläsionen zu überprüfen. Während in einer ersten Serie die 111In-PSMA I&T-SPECT/CT nur ca. die Hälfte der in der 68Ga-HBED-CC-PSMA-PET positive Läsionen nachweisen konnte, konnten mittels PSMA-RGS intraoperativ nicht nur annähernd alle PET-positiven Läsionen aufgespürt, sondern sogar fünf zusätzliche Läsionen im Vergleich zur 68Ga-HBED-CC-PSMA-PET gefunden werden. Im Follow-up von 55 Patienten zeigte sich bei 44 (80 %) resp. 29 (53 %) der Patienten ein prostataspezifischer Antigen(PSA)-Abfall von >50 % bzw. >90 %. Bei 34 (62 %) der Patienten wurde sogar ein PSA-Nadir <0,2 ng/ml erreicht. 15 (27 %) der Patienten erhielten eine weitere prostatakarzinomspezifische Therapie, die verbleibenden 40 (73 %) der Patienten erhielten keine weitere Therapie nach PSMA-RGS bei einem medianen Follow-up von 195 Tagen. Bei ca. 33 % der Patienten kam es nach PSMA-RGS zu postoperativen Komplikationen, welche jedoch überwiegend als geringgradig eingestuft wurden. Zusammenfassend zeigte sich die PSMA-RGS zur intraoperativen Detektion und Resektion der oft sehr kleinen metastatischen Läsionen als hilfreiche und praktikable Methode. Um gute onkologische Ergebnisse zu erzielen ist allerdings eine kritische Patientenauswahl, die sowohl klinische Parameter als auch die Ergebnisse der präoperativen 68Ga-PSMA-PET umfasst, von entscheidender Bedeutung.

Abstract

Recently, PSMA-radioguided surgery (PSMA-RGS) was introduced for targeted resection of localized prostate cancer recurrence. Prerequisite for preoperative patient selection and localization of tumor recurrence is a positive 68Ga-HBED-CC PSMA positron emission tomography (PET) scan with preferably only singular soft tissue or lymph node recurrence. After injection of In-PSMA I&T or Tc-PSMA-I&S single photon emission computer tomography (SPECT)/computer tomography (CT) examination is performed in every patient to verify radiotracer uptake in tumor lesions. In a preliminary study, 111In-PSMA I&T SPECT/CT could detect about half of the 68Ga-HBED-CC PSMA PET-positive lesions, while nearly all PET-positive lesions could be detected using PSMA-RGS and also five additional lesions compared to 68Ga-HBED-CC-PSMA PET. Follow-up data from 55 patients show a PSA reduction >50% and >90% in 44 (80%) and 29 (53%) patients, respectively. In 34 (62%) patients, a PSA drop to <0.2 ng/ml was observed. In all, 15 (27%) patients received further PC-specific treatment; the remaining 40 (73%) patients did not undergo further treatment. In 33% of patients, surgery-related complications were noted; however, most were regarded as minor. Thus, PSMA-RGS seems to be of high value in patients with localized prostate cancer recurrence with exact localization and resection of metastatic tissue. However, patient selection based on 68Ga-PSMA PET imaging and clinical parameters is crucial to obtain satisfactory oncological results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Abbreviations

PSMA-RGS:

„PSMA-radioguided surgery“

PET:

Positronen-Emissions-Tomographie

SPECT:

Single‐Photonen‐Emissions‐Computertomographie

CT:

Computertomographie

MRT:

Magnetresonanztomographie

PSMA:

Prostataspezifisches Membranantigen

99mTc:

Technetium-99m

Literatur

  1. Siegel R, Ma J, Zou Z et al (2014) Cancer statistics, 2014. CA Cancer J Clin 64(1):9–29

    Article  PubMed  Google Scholar 

  2. Boorjian SA, Thompson RH, Tollefson MK et al (2011) Long-term risk of clinical progression after biochemical recurrence following radical prostatectomy: the impact of time from surgery to recurrence. Eur Urol 59(6):893–899

    Article  PubMed  Google Scholar 

  3. Umbehr MH, Muntener M, Hany T et al (2013) The role of 11C-choline and 18F-fluorocholine positron emission tomography (PET) and PET/CT in prostate cancer: a systematic review and meta-analysis. Eur Urol 64(1):106–117

    Article  PubMed  Google Scholar 

  4. Eder M, Schafer M, Bauder-Wust U et al (2012) 68 Ga-complex lipophilicity and the targeting property of a urea-based PSMA inhibitor for PET imaging. Bioconjug Chem 23(4):688–697

    Article  CAS  PubMed  Google Scholar 

  5. Afshar-Oromieh A, Zechmann CM, Malcher A et al (2014) Comparison of PET imaging with a (68)Ga-labelled PSMA ligand and (18)F-choline-based PET/CT for the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging 41(1):11–20

    Article  CAS  PubMed  Google Scholar 

  6. Eiber M, Maurer T, Souvatzoglou M et al (2015) Evaluation of hybrid (6)(8)ga-PSMA Ligand PET/CT in 248 patients with biochemical recurrence after radical prostatectomy. J Nucl Med 56(5):668–674

    Article  PubMed  Google Scholar 

  7. Morigi JJ, Stricker PD, van Leeuwen PJ et al (2015) Prospective comparison of 18F-fluoromethylcholine versus 68 ga-PSMA PET/CT in prostate cancer patients who have rising PSA after curative treatment and are being considered for targeted therapy. J Nucl Med 56(8):1185–1190

    Article  CAS  PubMed  Google Scholar 

  8. Suardi N, Gandaglia G, Gallina A et al (2015) Long-term outcomes of salvage lymph node dissection for clinically recurrent prostate cancer: results of a single-institution series with a minimum follow-up of 5 years. Eur Urol 67(2):299–309

    Article  PubMed  Google Scholar 

  9. Abdollah F, Briganti A, Montorsi F et al (2015) Contemporary role of salvage lymphadenectomy in patients with recurrence following radical prostatectomy. Eur Urol 67(5):839–849

    Article  PubMed  Google Scholar 

  10. Schottelius M, Wirtz M, Eiber M et al (2015) [(111)In]PSMA-I&T: expanding the spectrum of PSMA-I&T applications towards SPECT and radioguided surgery. EJNMMI Res 5(1):68

    Article  PubMed  PubMed Central  Google Scholar 

  11. Maurer T, Weirich G, Schottelius M et al (2015) Prostate-specific membrane antigen-radioguided surgery for metastatic lymph nodes in prostate cancer. Eur Urol 68(3):530–534

    Article  PubMed  Google Scholar 

  12. Maurer T, Schwamborn K, Schottelius M et al (2016) PSMA Theranostics Using PET and Subsequent Radioguided Surgery in Recurrent Prostate Cancer. Clin Genitourin Cancer 14(5):e549–e552

    Article  PubMed  Google Scholar 

  13. Rauscher I, Maurer T, Souvatzoglou M et al (2016) Intrapatient comparison of 111in-PSMA I&T SPECT/CT and hybrid 68 ga-HBED-CC PSMA PET in patients with early recurrent prostate cancer. Clin Nucl Med 41(9):e397–e402

    Article  PubMed  Google Scholar 

  14. Robu S, Schottelius M, Eiber M et al (2016) Preclinical evaluation and first patient application of 99mTc-PSMA-I&S for SPECT imaging and radioguided surgery in prostate cancer. J Nucl Med. doi:10.2967/jnumed.116.178939

    PubMed  Google Scholar 

  15. Rigatti P, Suardi N, Briganti A et al (2011) Pelvic/retroperitoneal salvage lymph node dissection for patients treated with radical prostatectomy with biochemical recurrence and nodal recurrence detected by [11C]choline positron emission tomography/computed tomography. Eur Urol 60(5):935–943

    Article  PubMed  Google Scholar 

  16. Suardi N, Gandaglia G, Gallina A et al (2015) Long-term outcomes of salvage lymph node dissection for clinically recurrent prostate cancer: results of a single-institution series with a minimum follow-up of 5 years. Eur Urol 67(2):299–309

    Article  PubMed  Google Scholar 

  17. Jilg CA, Rischke HC, Reske SN et al (2012) Salvage lymph node dissection with adjuvant radiotherapy for nodal recurrence of prostate cancer. J Urol 188(6):2190–2197

    Article  CAS  PubMed  Google Scholar 

  18. Rischke HC, Schultze-Seemann W, Wieser G et al (2015) Adjuvant radiotherapy after salvage lymph node dissection because of nodal relapse of prostate cancer versus salvage lymph node dissection only. Strahlenther Onkol 191(4):310–320

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinikum rechts der Isar, Nuklearmedizinische Klinik und Poliklinik, Technische Universität München, München, Deutschland

    I. Rauscher & M. Eiber

  2. Urologische Klinik, Universitätsklinikum Freiburg, Freiburg, Deutschland

    C. A. Jilg

  3. Klinikum rechts der Isar, Urologische Klinik und Poliklinik, Technische Universität München, Ismaninger Str. 22, 81671, München, Deutschland

    J. E. Gschwend &  T. Maurer

Authors
  1. I. Rauscher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Eiber
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. A. Jilg
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. E. Gschwend
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. Maurer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Maurer.

Ethics declarations

Interessenkonflikt

I. Rauscher, M. Eiber, C. A. Jilg, J. E. Gschwend und T. Maurer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rauscher, I., Eiber, M., Jilg, C.A. et al. „PSMA-radioguided surgery“ beim lokal begrenzten Prostatakarzinomrezidiv. Urologe 56, 18–23 (2017). https://doi.org/10.1007/s00120-016-0275-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-016-0275-2

Schlüsselwörter

Keywords

Search

Navigation