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99mTc-PSMA targeted robot-assisted radioguided surgery during radical prostatectomy and extended lymph node dissection of prostate cancer patients
Objective The feasibility of tracer production of 99m technetium (Tc)-prostate-specific membrane antigen (PSMA)—I&S sterile cold kit, imaging with single photon emission tomography/computed tomography (SPECT/CT), and 99m Tc-PSMA-radioguided robot-assisted laparoscopic radical prostatectomy ( 99m...
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Published in: | Annals of nuclear medicine 2022-07, Vol.36 (7), p.597-609 |
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Main Authors: | , , , , , , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites Items that cite this one |
Online Access: | Get full text |
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Summary: | Objective
The feasibility of tracer production of
99m
technetium (Tc)-prostate-specific membrane antigen (PSMA)—I&S sterile cold kit, imaging with single photon emission tomography/computed tomography (SPECT/CT), and
99m
Tc-PSMA-radioguided robot-assisted laparoscopic radical prostatectomy (
99m
Tc-PSMA-RG-RALRP) technique for lymph node (LN) dissection of primary prostate cancer (PCa) patients were evaluated prospectively.
Methods
Fifteen primary PCa patients with intermediate- or high-risk score according to D’Amico risk stratification who had PSMA receptor affinity with Ga-68 PSMA-11 PET/CT were enrolled. After
99m
Tc-PSMA-I&S injection and SPECT/CT imaging,
99m
Tc-PSMA-RG-RALRP with DaVinci XI robotic platform and laparoscopic gamma probe were performed. Radioactive rating of resected tissue was compared with post-operative histopathology. Physiological and pathological uptakes of organs and tissues for both imaging modalities were compared.
Results
Physiological radiotracer distribution was similar for both imaging modalities. PCa lesions were much more visible on PET/CT. Metastatic LNs could not be visualized with SPECT/CT. Eighteen of 297 totally dissected LNs were metastatic, which were exactly the same with per-operative probe counts with sensitivity, specificity, accuracy, and negative and positive predictive value of all 100%. The median follow-up was 23.5 ± 4.6 months. tPSA reduction was > 98%. The 2.5 years biochemical recurrence-free survival, PCa-specific treatment-free survival and overall survival rates were 86,7%, 66,7% and 100%, respectively.
Conclusion
Tc-99 m-PSMA-RG-RALRP is a promising technique for extended pelvic lymph node dissection (ePLND) during robotic surgery, which may shorten the operation time and reduce complication risks. If LN metastases is detected during surgery with PSMA-targeted probe, it may be an early indicator of PCa-spesific treatment planning. Tc-99 m-PSMA-I&S SPECT/CT is not as successful as Ga-68 PSMA-11 PET/CT for diagnosis of primary PCA lesions or LN metastases. |
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ISSN: | 0914-7187 1864-6433 |
DOI: | 10.1007/s12149-022-01741-9 |