In:
BJU International, Wiley, Vol. 120, No. 1 ( 2017-07), p. 40-47
Abstract:
To evaluate the use of 111 In‐labelled prostate‐specific membrane antigen ( PSMA )‐I & T‐based radioguided surgery ( 111 In‐ PSMA ‐ RGS ) for salvage surgery in recurrent prostate cancer ( PC a) using comparison of intra‐operative gamma probe measurements with histopathological results of dissected specimens. In addition, to determine the success of 111 In‐ PSMA ‐ RGS with regard to postoperative prostate‐specific antigen ( PSA ) responses, PC a‐specific treatment‐free survival rates and postoperative complication rates. Patients and Methods A total of 31 consecutive patients with localized recurrent PC a undergoing salvage surgery with PSMA ‐targeted radioguided surgery using a 111 In‐labelled PSMA ligand between April 2014 and July 2015 were retrospectively included in this study. The preoperative (interquartile range; range) median PSA level was 1.3 (0.57–2.53 ng/mL; 0.2–13.9 ng/mL). Results of ex vivo radioactivity rating (positive vs negative) of resected tissue specimens were compared with findings of postoperative histological analysis. Best PSA response without additional treatment was determined after 111 In‐ PSMA ‐ RGS , and salvage‐surgery‐related postoperative complications and PC a‐specific additional treatments were recorded. Results In 30/31 patients, 111 In‐ PSMA ‐ RGS allowed intra‐operative identification of metastatic lesions. In total, 145 surgical specimens were removed and 51 showed metastatic involvement at histological analysis. According to 111 In‐ PSMA ‐ RGS ex vivo measurements, 48 specimens were correctly classified as metastatic and 87 as cancer‐free, four were false‐negative and six were false‐positive compared with histological evaluation. Follow‐up information was available for 30/31 patients. PSA declines of 〉 50% and 〉 90% were observed in 23/30 patients and in 16/30 patients, respectively. In 18/30 patients, a PSA decline to 〈 0.2 ng/mL was observed. In 10/30 patients further PC a‐specific treatment was given after a median (range) of 125 (48–454) days post‐ 111 In‐ PSMA ‐ RGS . The remaining 20 patients remained treatment‐free at a median (range) follow‐up of 337 (81–591) days. Of 30 patients, 10 presented with surgery‐related complications (Clavien–Dindo grade 1, n = 6, Clavien–Dindo grade 3b, n = 4). Conclusion 111 In‐ PSMA ‐ RGS proved to be of high value for intra‐operative detection of even small metastatic lesions in patients with PC a scheduled for salvage lymphadenectomy. It allows the exact localization and resection of metastatic tissue during 111 In‐ PSMA ‐ RGS and is therefore anticipated to have a beneficial influence on further disease progression; however, identification of suitable patients on the basis of PSMA ‐positron‐emission tomography imaging as well as clinical variables is essential for satisfactory results to be obtained.
Type of Medium:
Online Resource
ISSN:
1464-4096
,
1464-410X
DOI:
10.1111/bju.2017.120.issue-1
Language:
English
Publisher:
Wiley
Publication Date:
2017
detail.hit.zdb_id:
2019983-1
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