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Eur Urol. 2015 Sep;68(3):530-4. doi: 10.1016/j.eururo.2015.04.034. Epub 2015 May 6.

Prostate-specific membrane antigen-radioguided surgery for metastatic lymph nodes in prostate cancer.

Author information

1
Department of Urology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany. Electronic address: t.maurer@lrz.tum.de.
2
Institute of Pathology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.
3
Pharmaceutical Radiochemistry, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.
4
Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.
5
Computer Aided Medical Procedures, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.
6
Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany; Computer Aided Medical Procedures, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.
7
Department of Urology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.

Abstract

With the advent of (68)Ga-labeled prostate-specific membrane antigen-N,N'-bis[2-hydroxy-5-(carboxyethyl)benzyl]ethylenediamine-N,N'-diacetic acid ((68)Ga-PSMA-HBED-CC) positron emission tomography (PET) hybrid imaging in prostate cancer (PCa), even small metastatic lymph nodes (LNs) can be visualized. However, intraoperative detection of such LNs may not be easy owing to their inconspicuous morphology and/or atypical localization. The aim of our feasibility study was to evaluate PSMA-radioguided surgery for detection of metastatic LNs. One patient with primary PCa and evidence of LN metastases and four PCa patients with evidence of recurrent disease to regional LNs on (68)Ga-PSMA-HBED-CC PET hybrid imaging received an intravenous injection of an (111)In-PSMA investigation and therapy agent 24h before surgery. Metastatic LNs were tracked intraoperatively using a gamma probe with acoustic and visual feedback. All radioactive-positive LN specimens detected in vivo were confirmed by ex vivo measurements and corresponded to PSMA-avid metastatic disease according to histopathology analysis. Intraoperative use of the gamma probe detected all PSMA-positive lesions identified on preoperative (68)Ga-PSMA-HBED-CC PET. Detection of small subcentimeter metastatic LNs was facilitated, and PSMA-radioguided surgery in two patients revealed additional lesions close to known tumor deposits that were not detected by preoperative (68)Ga-PSMA-HBED-CC PET. However, greater patient numbers and long-term follow-up data are needed to determine the future role of PSMA-radioguided surgery.

KEYWORDS:

Positron emission tomography; Prostate cancer; Prostate-specific membrane antigen; Radioguided

PMID:
25957851
DOI:
10.1016/j.eururo.2015.04.034
[Indexed for MEDLINE]

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