PD27-04 ROBOT-ASSISTED PSMA-RADIOGUIDED SALVAGE SURGERY IN RECURRENT PROSTATE CANCER USING A DROP-IN GAMMA PROBE - A PROSPECTIVE FEASIBILITY STUDY

Field: Medicine (Health Sciences)

You have accessJournal of UrologyCME1 May 2022PD27-04 ROBOT-ASSISTED PSMA-RADIOGUIDED SALVAGE SURGERY IN RECURRENT PROSTATE CANCER USING A DROP-IN GAMMA PROBE - A PROSPECTIVE FEASIBILITY STUDY Hilda de Barros, Matthias van Oosterom, Maarten Donswijk, Jeroen Hendrikx, André Vis, Tobias Maurer, Fijs van Leeuwen, Henk van der Poel, and Pim van Leeuwen Hilda de BarrosHilda de Barros More articles by this author , Matthias van OosteromMatthias van Oosterom More articles by this author , Maarten DonswijkMaarten Donswijk More articles by this author , Jeroen HendrikxJeroen Hendrikx More articles by this author , André VisAndré Vis More articles by this author , Tobias MaurerTobias Maurer More articles by this author , Fijs van LeeuwenFijs van Leeuwen More articles by this author , Henk van der PoelHenk van der Poel More articles by this author , and Pim van LeeuwenPim van Leeuwen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002575.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intraoperative Prostate-Specific Membrane Antigen (PSMA)-targeted radioguidance was proven to be valuable for the detection of PCa lesions during open salvage surgery. Rapid extension of robot-assisted, minimally invasive surgery has increased the need to make PSMA-radioguided surgery (RGS) robot compliant. Here we aim to evaluate whether the miniaturized DROP-IN gamma probe facilitates translation of PSMA-targeted radioguidance to salvage robotic surgery in men with recurrent PCa. METHODS: This prospective feasibility study (NCT03857113) included twenty patients with a biochemical recurrence (PSA ≥ 0.2 ng/ml) after radical prostatectomy or radiotherapy with up to 2 pelvic PCa recurrences (either nodal or local) on PSMA positron emission tomography (PET)/CT. Patients received an intravenous injection of 99mTc-PSMA I&S (median activity 541 MBq, IQR 526-578) followed by scintigraphy as a control for tracer injection and distribution. Robot-assisted PSMA-RGS was realized using the tethered gamma probe 19-23 hours post-injection. The primary endpoint was the feasibility of PSMA-RGS in a robotic setting. Secondary endpoints were the comparison of the radioactive status (i.e., positive or negative) of the resected specimens and final histopathology results, the frequency of >50% prostate-specific antigen (PSA) reduction, complete biochemical response (cBR; PSA <0.2 ng/ml) 6 weeks postoperatively, and complications according to Clavien-Dindo 30 days postoperatively. RESULTS: At surgery, the median age was 68 years (IQR 66-72) and median PSA was 1.02 ng/ml (IQR 0.46-2.43). Using the DROP-IN probe, 19 out of 21 (90%) PSMA PET-avid lesions could be resected robotically with a median surgical duration of 128 min (IQR 103-157). On a per-lesion basis, the overall diagnostic sensitivity and specificity of robot-assisted PSMA-RGS was 86% and 100%, respectively. A >50% PSA reduction and cBR was seen in 12 out of 18 (67%) and 3 out of 18 (17%) patients, respectively. No Clavien-Dindo grade ≥2 complications occurred. CONCLUSIONS: The DROP-IN probe helps to realize robot-assisted PSMA-RGS. The procedure is technically feasible for the intraoperative detection of nodal or local PSMA-avid PCa recurrences. Source of Funding: Partly supported by an NWO-TTW-VICI grant (TTW 16141) © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e494 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hilda de Barros More articles by this author Matthias van Oosterom More articles by this author Maarten Donswijk More articles by this author Jeroen Hendrikx More articles by this author André Vis More articles by this author Tobias Maurer More articles by this author Fijs van Leeuwen More articles by this author Henk van der Poel More articles by this author Pim van Leeuwen More articles by this author Expand All Advertisement PDF DownloadLoading ...