Quarta Leonardo, Stabile Armando, Chiti Arturo, Montorsi Francesco, Briganti Alberto, Gandaglia Giorgio
Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
Eur Urol Focus. 2025 Jan;11(1):29-32. doi: 10.1016/j.euf.2025.05.003. Epub 2025 May 13.
Prostate-specific membrane antigen radioguided surgery (PSMA-RGS) is an emerging technique that provides real-time intraoperative guidance for identification of lymph node metastases (LNMs) in patients with prostate cancer (PC). PSMA-RGS uses PSMA ligands labeled with radionuclides that emit γ or β particles and has shown promise in enhancing the accuracy of surgery. Introduced for salvage lymph node dissection in patients experiencing biochemical recurrence, PSMA-RGS has demonstrated high specificity and positive predictive value, although sensitivity remains limited for micrometastatic disease. Recent studies on PSMA-RGS during extended pelvic lymph node dissection in the primary setting showed that it is safe and feasible, with superior accuracy in comparison to preoperative PSMA positron emission tomography. Despite its advantages, PSMA-RGS has limited sensitivity for micrometastatic LNMs because of spatial resolution for the probe. PSMA-RGS represents a promising tool for optimizing surgical management in PC. However, future studies with long-term follow-up are needed to refine detection strategies and evaluate its oncological impact. PATIENT SUMMARY: Radioguided surgery using radioactive compounds that bind to a protein called PSMA (prostate-specific membrane antigen) is a safe procedure that may help surgeons in identifying metastasis in lymph nodes during robot-assisted surgery for prostate cancer. While this technique has potential to enhance treatment outcomes, further studies are necessary to confirm its long-term benefits.
前列腺特异性膜抗原放射性引导手术（PSMA-RGS）是一种新兴技术，可为前列腺癌（PC）患者识别淋巴结转移（LNM）提供术中实时引导。PSMA-RGS使用标记有发射γ或β粒子的放射性核素的PSMA配体，并已显示出提高手术准确性的前景。PSMA-RGS最初用于生化复发患者的挽救性淋巴结清扫，已证明具有高特异性和阳性预测价值，尽管对微转移疾病的敏感性仍然有限。最近在初次手术的扩大盆腔淋巴结清扫术中对PSMA-RGS的研究表明，它是安全可行的，与术前PSMA正电子发射断层扫描相比，准确性更高。尽管具有优势，但由于探头的空间分辨率，PSMA-RGS对微转移LNM的敏感性有限。PSMA-RGS是优化PC手术管理的一种有前景的工具。然而，需要进行长期随访的未来研究来完善检测策略并评估其肿瘤学影响。患者总结：使用与一种名为PSMA（前列腺特异性膜抗原）的蛋白质结合的放射性化合物进行放射性引导手术是一种安全的手术，可能有助于外科医生在前列腺癌机器人辅助手术期间识别淋巴结转移。虽然这项技术有可能提高治疗效果，但需要进一步研究来证实其长期益处。
