Department of Urology, St. Josef Medical Center, University of Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany.
Department of Nuclear Medicine, University of Regensburg, 93053, Regensburg, Germany.
World J Urol. 2024 Aug 12;42(1):483. doi: 10.1007/s00345-024-05189-6.
The higher detection efficacy of PSMA PET for oligometastatic recurrence of prostate cancer has promoted new loco-regional treatment options. PSMA-targeted radioguided surgery (PSMA-RGS) was introduced to facilitate salvage surgery of small tumor deposits. The objectives of this retrospective analysis are to describe an independent single-center consecutive cohort of patients undergoing PSMA-RGS and to evaluate its clinical and oncological outcomes.
Between 2018 and 2022, 53 patients were treated with PSMA-RGS and 50 patients were available for final analyses. All patients were initially treated with radical prostatectomy (RP) and presented with biochemical recurrence (BCR) with at least one positive lesion on PSMA-PET imaging. After preparation of 99mTc-PSMA-I&S and intravenous injection, surgery was performed by using a gamma-probe intraoperatively.
Median age was 70 years (IQR 65-73) and the median PSA at salvage surgery was 1.2 ng/mL (IQR 0.6-3.0). In all patients pathologically positive lesions could be removed during PSMA-RGS. 29 (58%) patients had one pathologically positive lesion, 14 (28%) had two and 7 (14%) had three or more, respectively. The overall complication rate was 26% with 4 (8%), 1 (2%), and 8 (16%) having Clavien-Dindo (CD) type I, II, and IIIb complications, respectively. During the follow-up period 31 (62%) patients experienced BCR and 29 (58%) received further therapy.
PSMA-RGS is a promising treatment option to enhance salvage surgery in early biochemical recurrence. However, only 42% of the patients treated with PSMA RGS remain without a biochemical recurrence. Further research is mandatory to identify patients, who profit from PSMA-RGS.
PSMA PET 对前列腺癌寡转移复发的更高检测效果促进了新的局部区域治疗选择。PSMA 靶向放射性引导手术（PSMA-RGS）被引入以促进小肿瘤沉积物的挽救性手术。本回顾性分析的目的是描述接受 PSMA-RGS 治疗的独立单中心连续队列患者，并评估其临床和肿瘤学结果。
在 2018 年至 2022 年期间，53 名患者接受了 PSMA-RGS 治疗，其中 50 名患者可进行最终分析。所有患者最初均接受根治性前列腺切除术（RP）治疗，并在 PSMA-PET 成像上至少有一个阳性病变后出现生化复发（BCR）。在准备好 99mTc-PSMA-I&S 并静脉注射后，术中使用伽马探针进行手术。
中位年龄为 70 岁（IQR 65-73），挽救性手术时的中位 PSA 为 1.2ng/ml（IQR 0.6-3.0）。在所有患者中，PSMA-RGS 期间均可切除病理上阳性的病变。29 名（58%）患者有一个病理阳性病变，14 名（28%）有两个，7 名（14%）有三个或更多。总的并发症发生率为 26%，其中 4 名（8%）、1 名（2%）和 8 名（16%）分别患有 Clavien-Dindo（CD）I、II 和 IIIb 级并发症。在随访期间，31 名（62%）患者出现 BCR，29 名（58%）患者接受了进一步治疗。
PSMA-RGS 是增强早期生化复发时挽救性手术的一种很有前途的治疗选择。然而，仅 42%接受 PSMA RGS 治疗的患者仍无生化复发。有必要进一步研究以确定从 PSMA-RGS 中获益的患者。
