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 (68)Ga-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, (111)In-PSMA I&T SPECT/CT could detect about half of the (68)Ga-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 (68)Ga-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 (68)Ga-PSMA PET imaging and clinical parameters is crucial to obtain satisfactory oncological results.
Der Urologe. Ausg. A. 2016 Jan 24 [Epub ahead of print]
I Rauscher, M Eiber, C A Jilg, J E Gschwend, T Maurer
Klinikum rechts der Isar, Nuklearmedizinische Klinik und Poliklinik, Technische Universität München, München, Deutschland., Urologische Klinik, Universitätsklinikum Freiburg, Freiburg, Deutschland., Klinikum rechts der Isar, Urologische Klinik und Poliklinik, Technische Universität München, Ismaninger Str. 22, 81671, München, Deutschland., Klinikum rechts der Isar, Urologische Klinik und Poliklinik, Technische Universität München, Ismaninger Str. 22, 81671, München, Deutschland. .