Feasibility of Using a Novel Drop-In Gamma Probe for 99m Tc-PSMA-I&S-Guided Lymph Node Detection During Robot-Assisted Radical Prostatectomy for Primary Prostate Cancer.

Autor:	Harke NN; From the Departments of Urology., Fuhrmann C; From the Departments of Urology., Czerner C; Nuclear Medicine., Rudolf F; Radiation Protection, Hannover Medical School, Hannover, Germany., Ross TL; Nuclear Medicine., Katzendorn O; From the Departments of Urology., Bengel F; Nuclear Medicine., Kuczyk MA; From the Departments of Urology., Weiberg D; Nuclear Medicine., Derlin T; Nuclear Medicine.
Jazyk:	angličtina
Zdroj:	Clinical nuclear medicine [Clin Nucl Med] 2024 Oct 01; Vol. 49 (10), pp. 948-952. Date of Electronic Publication: 2024 Jul 03.
DOI:	10.1097/RLU.0000000000005385
Abstrakt:	Purpose: Prostate-specific membrane antigen (PSMA)-targeted radioguided surgery (RGS) has gained increased interest in prostate cancer (PCa). This analysis aims to evaluate the feasibility, safety, and limitations of RGS with a novel drop-in gamma probe in primary PCa. Patients and Methods: The data of 13 patients with primary PCa undergoing RGS were analyzed retrospectively. After preoperative administration of 99m Tc-PSMA-I&S, a SPECT/CT was conducted and a robotic radical prostatectomy was performed the following day including intraoperative assessment of the lymph node stations using a novel robotic drop-in gamma probe. This was followed by an extended pelvic lymph node dissection (ePLND) with ex vivo control measurement using the drop-in and a conventional rigid gamma probe. Results: Eleven patients (median PSA value of 11 ng/mL) had high-risk and 2 patients had intermediate-risk PCa. Overall, a median of 22 ePLND lymph nodes were dissected. In 1 patient, preoperative SPECT/CT imaging showed suspicious lymph nodes, which could be confirmed intraoperatively with the robotic drop-in probe and subsequently in the final histopathological analysis. RGS failed to identify 2 patients with micrometastases (<3 mm) preoperatively and intraoperatively. No postoperative complications related to 99m Tc-PSMA-I&S RGS or ePLND occurred. Conclusions: RGS with the novel drop-in gamma probe and 99m Tc-PSMA-I&S allows for a reliable intraoperative screening for lymph node metastases in robot-assisted radical prostatectomy for primary PCa with an acceptable safety profile. However, limitations in the detection of micrometastases need to be overcome before omitting extended ePLND in patients at risk for lymphatic spread. Competing Interests: Conflicts of interest and sources of funding: No external funding or sponsorship was received for this study or publication of this article. N.N.H. has received honoraria for presentations from Intuitive Surgical, Janssen, and Pajunk, and compensation for travel from Bayer, Astellas, Pfizer, and Janssen. C.F. has obtained compensation for travel by Lightpoint. O.K. has received compensation for travel from Astellas. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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