Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
Radboud University Nijmegen, Institute for Molecules and Materials, Systems Chemistry, Nijmegen, The Netherlands.
Theranostics. 2019 Sep 20;9(23):6824-6839. doi: 10.7150/thno.36739. eCollection 2019.
Despite recent improvements in imaging and therapy, prostate cancer (PCa) still causes substantial morbidity and mortality. In surgical treatment, incomplete resection of PCa and understaging of possible undetected metastases may lead to disease recurrence and consequently poor patient outcome. To increase the chance of accurate staging and subsequently complete removal of all cancerous tissue, prostate specific membrane antigen (PSMA) targeting agents may provide the surgeon an aid for the intraoperative detection and resection of PCa lesions. Two modalities suitable for this purpose are radionuclide detection, which allows sensitive intraoperative localization of tumor lesions with a gamma probe, and fluorescence imaging, allowing tumor visualization and delineation. Next to fluorescence, use of photosensitizers may enable intraoperative targeted photodynamic therapy to eradicate remaining tumor lesions. Since radiodetection and optical imaging techniques each have their own strengths and weaknesses, a combination of both modalities could be of additional value. Here, we provide an overview of recent preclinical and clinical advances in PSMA-targeted radio- and fluorescence-guided surgery of PCa.
尽管影像学和治疗技术最近有所改善，但前列腺癌（PCa）仍然会导致严重的发病率和死亡率。在手术治疗中，PCa 的不完全切除和对可能未检测到的转移灶的低估可能导致疾病复发，从而导致患者预后不良。为了提高准确分期的机会，并随后完全切除所有癌组织，前列腺特异性膜抗原（PSMA）靶向药物可能为外科医生提供一种辅助手段，用于术中检测和切除 PCa 病变。两种适合此目的的方法是放射性核素检测，它允许使用伽马探针对肿瘤病变进行敏感的术中定位，以及荧光成像，允许肿瘤可视化和描绘。除了荧光之外，使用光敏剂还可以实现术中靶向光动力疗法以根除残留的肿瘤病变。由于放射性检测和光学成像技术各自具有优势和劣势，因此两种模式的结合可能具有额外的价值。在这里，我们概述了 PSMA 靶向放射性和荧光引导 PCa 手术的最新临床前和临床进展。
