99m Technetium-Based PSMA-Radioguided Surgery in Recurrent Prostate Cancer

[snoraste]

In case you did not see:

"TAKE-HOME MESSAGE

In this analysis, the authors enrolled 31 patients who had experienced biochemical recurrence after radical prostatectomy. Patients underwent 68Ga prostate-specific membrane antigen (PSMA) PET imaging to identify potential lymph node (LN) metastases. 99mTc-PSMA was injected intravenously the day before surgery, and patients underwent open salvage LN dissection. After removal of all lesions visualized on 68Ga-PSMA-PET, gamma probe measurements were used in vivo to identify additional lesions. Of 132 resected LN specimens, the gamma probe correctly classified 46 positive specimens as cancerous and 74 negative specimens as cancer-free. This method yielded a sensitivity of 84%, specificity of 100%, positive predictive value of 100%, negative predictive value of 89%, and accuracy of 93%. On follow-up, 80% of patients had ≤50% decline in PSA, and 67% of patients had complete response.

The authors demonstrated the feasibility of 99mTc-PSMA radioguided salvage lymphadenectomy while cautioning the limitations of this approach for detecting low-volume microscopic disease. They suggest validation of these findings in prospective trials, considering that the current study suggests a high potential to delay systemic treatment and positively influence disease progression.

– Jeffrey J. Tosoian, MD, MPH"

practiceupdate.com/C/82716/...

[GP24]

You can get this treatment outside clinical trials in Hamburg with Dr. Maurer and in Munich with Prof. Gschwend. Prof. Gschwend mentioned that he can remove 99% of the affected lymph nodes detected with a PSMA PET/CT this way.

[tallguy2]

Thank you for posting this. My care team discounted lymph node removal due to risk of lymphodema. I had 26 days of radiation instead. Maybe I was too hasty? I understand Memorial Sloan Kettering has a clinical trial involving surgery for remaining lymph nodes lit up on scans, plus radiation.