Horn T, Rauscher I, Eiber M, Gschwend J E, Maurer T
Klinikum rechts der Isar, Urologische Klinik und Poliklinik, Technische Universität München, Ismaninger Str. 22, 81671, München, Deutschland.
Klinikum rechts der Isar, Nuklearmedizinische Klinik und Poliklinik, Technische Universität München, München, Deutschland.
Urologe A. 2017 Nov;56(11):1417-1423. doi: 10.1007/s00120-017-0516-z.
Recently, prostate-specific membrane antigen radioguided surgery (PSMA-RGS) was introduced for targeted resection of localised prostate cancer recurrence. Preliminary results show that PSMA-RGS is very sensitive and specific in tracking suspicious lesions intraoperatively. Prerequisite for PSMA-RGS is a positive Ga-PSMA positron emission tomography (PET) scan with a preferably singular soft tissue or lymph node recurrence. The first 63 patients treated with PSMA-RGS were analyzed. The extracorporal analysis of a total of 277 tissue specimens yielded the following test quality criteria regarding the presence of malignant tissue: sensitivity 86.2%, specificity 96.4%, positive predictive value 94%, negative predictive value 91.5%. Oncological follow-up data was available from 59 patients. There was a drop in PSA (prostate specific antigen) below 0.2 ng/ml in 38 patients (67%). Of these 38 patients, 17 (45%) are free of biochemical recurrence after a median follow-up of 12.3 months (6.7-31.9 months). Clavien-Dindo grade III complications occurred in 6 of 63 patients (9.5%). In summary, PSMA-RGS proved to be of high value in patients with localised prostate cancer recurrence for exact localisation and resection of oftentimes small metastatic tissue using intraoperative and ex vivo gamma-probe measurements. Furthermore, PSMA-RGS has the potential to positively influence oncological outcomes. However, patient identification on the basis of Ga-PSMA PET imaging and clinical parameters is crucial to obtain satisfactory results.
最近，前列腺特异性膜抗原放射性引导手术（PSMA-RGS）被用于局部前列腺癌复发的靶向切除。初步结果表明，PSMA-RGS在术中追踪可疑病变方面非常敏感且特异。PSMA-RGS的前提是Ga-PSMA正电子发射断层扫描（PET）结果为阳性，最好是单一的软组织或淋巴结复发。对首批接受PSMA-RGS治疗的63例患者进行了分析。对总共277份组织标本进行的体外分析得出了关于恶性组织存在情况的以下检测质量标准：敏感性86.2%，特异性96.4%，阳性预测值94%，阴性预测值91.5%。59例患者有肿瘤学随访数据。38例患者（67%）的前列腺特异性抗原（PSA）降至0.2 ng/ml以下。在这38例患者中，17例（45%）在中位随访12.3个月（6.7 - 31.9个月）后无生化复发。63例患者中有6例（9.5%）发生Clavien-DindoⅢ级并发症。总之，PSMA-RGS在局部前列腺癌复发患者中被证明具有很高的价值，可通过术中及体外γ探测仪测量对常常较小的转移组织进行精确的定位和切除。此外，PSMA-RGS有可能对肿瘤学结局产生积极影响。然而，基于Ga-PSMA PET成像和临床参数进行患者识别对于获得满意结果至关重要。
