Weiner Adam B, Ells Zachary, Meyer Catherine, Dahlbom Magnus, Sennung David, Varughese Deepu, Ludwig Vinicius B, Carlucci Giuseppe, Grant Raeven, Czernin Johannes, Calais Jeremie, Reiter Robert E
Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA.
Institute for Precision Health, University of California-Los Angeles, Los Angeles, CA, USA.
Eur Urol Open Sci. 2024 Oct 15;70:36-42. doi: 10.1016/j.euros.2024.09.004. eCollection 2024 Dec.
Prostate-specific membrane antigen (PSMA) radioguided salvage pelvic lymph node dissection (S-PLND) has emerged as a feasible treatment option for prostate cancer recurrence following initial surgery. This study aims to evaluate the feasibility and short-term outcomes of PSMA radioguided S-PLND.
From a prospective trial of Tc-PSMA-I&S followed by PSMA radioguided robotic surgery, we evaluated patients treated for node-only recurrence following radical therapy. The primary outcome was serum prostate-specific antigen (PSA) response 3 mo after surgery.
Among 14 patients (enrolled from June 2021 to June 2023), the median age was 65 yr. One patient had undergone primary whole gland ultrasound ablation, while the rest received prior prostatectomy. The median (interquartile range) time from primary treatment to PSMA positron emission tomography (PET) was 4.1 (2.9-8.3) yr, and 21 total pelvic targets were noted on PSMA PET: one in eight patients (67%), two in five patients (29%), and three in one patient (7%). Targets were successfully detected intraoperatively and removed in 13/14 (93%) patients. Cancer was noted on histopathology in 90% (19/21) of PSMA PET targets, 94% (17/18) of single-photon emission computed tomography targets, and 82% (14/17) of gamma probe targets. There were no adverse effects due to the radiotracer, and there were no complications after surgery. PSA at 3 mo was <0.2 ng/ml in two (14%) patients, and a ≥50% decline was noted in five (36%) patients. After a mean follow-up of 8.3 mo, the median time to next treatment was 11.7 mo, which was noted in nine patients.
PSMA radioguided S-PLND is feasible and safe. However, the clinical role and the honing of technique and patient selection will be required in prospective studies.
In 14 patients who had prostate cancer recurrence after their initial treatment, performing surgery using radioactive tags to location is possible. However, futures studies are still needed to improve the technique.
前列腺特异性膜抗原（PSMA）放射性引导挽救性盆腔淋巴结清扫术（S-PLND）已成为初始手术后前列腺癌复发的一种可行治疗选择。本研究旨在评估PSMA放射性引导S-PLND的可行性和短期疗效。
从一项先进行Tc-PSMA-I&S然后行PSMA放射性引导机器人手术的前瞻性试验中，我们评估了接受根治性治疗后仅出现淋巴结复发的患者。主要结局是术后3个月时血清前列腺特异性抗原（PSA）反应。
在14例患者（2021年6月至2023年6月入组）中，中位年龄为65岁。1例患者曾接受原发性全腺超声消融，其余患者曾接受前列腺切除术。从初次治疗到PSMA正电子发射断层扫描（PET）的中位（四分位间距）时间为4.1（2.9 - 8.3）年，PSMA PET上共发现21个盆腔靶点：8例患者中有1个靶点（67%），5例患者中有2个靶点（29%），1例患者中有3个靶点（7%）。13/14（93%）例患者术中成功检测到靶点并切除。PSMA PET靶点的组织病理学检查发现癌症的比例为90%（19/21），单光子发射计算机断层扫描靶点为94%（17/18），γ探针靶点为82%（14/17）。没有因放射性示踪剂导致的不良反应，术后也没有并发症。2例（14%）患者术后3个月时PSA<0.2 ng/ml，5例（36%）患者PSA下降≥50%。平均随访8.3个月后，9例患者的下次治疗中位时间为11.7个月。
PSMA放射性引导S-PLND是可行且安全的。然而，前瞻性研究将需要明确其临床作用以及技术和患者选择的优化。
在14例初始治疗后出现前列腺癌复发的患者中，使用放射性标记定位进行手术是可行的。然而，仍需要进一步研究来改进该技术。
