MP82-10 PSMA-RADIOGUIDED SURGERY: INTRODUCING MOLECULAR SURGERY IN PATIENTS WITH RECURRENT PROSTATE CANCER (2015)

You have accessJournal of UrologyProstate Cancer: Advanced II1 Apr 2015MP82-10 PSMA-RADIOGUIDED SURGERY: INTRODUCING MOLECULAR SURGERY IN PATIENTS WITH RECURRENT PROSTATE CANCER Tobias Maurer, Martina Weineisen, Hans-Jürgen Wester, Margret Schottelius, Asli Okur, Gregor Weirich, Hubert Kübler, Markus Schwaiger, Jürgen Erich Gschwend, Benjamin Frisch, and Matthias Eiber Tobias MaurerTobias Maurer More articles by this author , Martina WeineisenMartina Weineisen More articles by this author , Hans-Jürgen WesterHans-Jürgen Wester More articles by this author , Margret SchotteliusMargret Schottelius More articles by this author , Asli OkurAsli Okur More articles by this author , Gregor WeirichGregor Weirich More articles by this author , Hubert KüblerHubert Kübler More articles by this author , Markus SchwaigerMarkus Schwaiger More articles by this author , Jürgen Erich GschwendJürgen Erich Gschwend More articles by this author , Benjamin FrischBenjamin Frisch More articles by this author , and Matthias EiberMatthias Eiber More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.529AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES With the advent of 68Ga-HBED-PSMA PET hybrid imaging techniques even small and atypical localized metastatic lesions of prostate cancer (PCa) can be visualized. However, these lesions might not be easy to localize intraoperatively. Thus, the aim of this feasibility study was to evaluate intraoperative detection of metastatic lesions using a gamma probe after injection of a radiolabelled PSMA-ligand in correlation with postoperative histological findings. METHODS 9 consecutive PCa patients with rising PSA after curative treatment (Median: 1.3ng/ml, range: 0.2 – 4.7ng/ml) and evidence of recurrent disease within the pelvis on 68Ga-HBED-PSMA PET hybrid imaging were included in this analysis. 24 hours before surgery patients received an intravenous injection of 111In-labelled PSMA-I&T. Intraoperatively, metastatic lesions were detected by gamma probe with acoustic and visual feedback. Using the freehand SPECT technique optical tracking of the gamma probe allowed augmenting the live video stream of the field of surgery with reconstructed 3D image showing the position of positive lesions. Results of ex vivo radioactive rating (positive vs. negative) of resected tissue were compared to findings of postoperative histological analysis. RESULTS In total, 32 separate histological specimens were evaluated (Median: 2, range: 2 – 7) and 15 specimens contained metastatic lesions at histological analysis. Lesions declared radioactive-positive intraoperatively and exhibiting a positive signal by the gamma probe ex vivo corresponded to metastatic PCa lesions with a sensitivity of 93.3% and a specificity of 100%. Detection of lesions as well as complete resection of even small metastatic lymph nodes was facilitated by the use of the gamma probe. Compared to preoperative 68Ga-HBED-PSMA PET hybrid imaging the intraoperative use of the gamma probe might even be more accurate as it detected all positive lesions and even additional lesions as small as 2mm. CONCLUSIONS In this initial series, PSMA-radioguided surgery proved to be of high value for intraoperative detection of even small metastatic lesions in PCa patients. However, adequate patient selection for this individual treatment concept is crucial. Furthermore, greater patient numbers including follow-up data are needed to determine its possible role in clinical routine. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1040-e1041 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tobias Maurer More articles by this author Martina Weineisen More articles by this author Hans-Jürgen Wester More articles by this author Margret Schottelius More articles by this author Asli Okur More articles by this author Gregor Weirich More articles by this author Hubert Kübler More articles by this author Markus Schwaiger More articles by this author Jürgen Erich Gschwend More articles by this author Benjamin Frisch More articles by this author Matthias Eiber More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...