Nuklearmedizin 2019; 58(02): 134
DOI: 10.1055/s-0039-1683614
Vorträge
Theranostik: Prostata-Karzinom
Georg Thieme Verlag KG Stuttgart · New York

Intraoperative 68Gallium PSMA Cerenkov Luminescence Imaging in radical prostatectomy – a feasibility study

P Fragoso Costa
1   University Hospital Essen, Department of Nuclear Medicine, Essen
,
C Darr
2   University Hospital Essen, Department of Urology and Urological Oncology, Essen
,
I Binse
1   University Hospital Essen, Department of Nuclear Medicine, Essen
,
M Grootendorst
3   Lightpoint Medical Ltd, Clinical Research, Chesham, United Kingdom
,
K Herrmann
1   University Hospital Essen, Department of Nuclear Medicine, Essen
,
B Hadaschik
2   University Hospital Essen, Department of Urology and Urological Oncology, Essen
,
N Harke
2   University Hospital Essen, Department of Urology and Urological Oncology, Essen
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2019 (online)

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Ziel/Aim:

Cerenkov Luminescence Imaging (CLI) is a molecular imaging technique that detects light emitted by Positron Emission Tomography (PET) radiopharmaceuticals. This first-in-men study evaluates 68Ga-PSMA for intraoperative assessment of tumor margins at time of robot-assisted radical prostatectomy.

Methodik/Methods:

3 – 4 hours prior to surgery, PSMA-PET/CT was performed after intravenous injection of 68Ga-PSMA. Scan results were assessed by the specialists of nuclear medicine and urology. Radical prostatectomy was performed robotically and the prostate specimen was imaged with a CLI imager (Lightpoint Medical Ltd, UK) intraoperatively immediately after excision with mean measurement of the radiance on the surface. The agreement of margin distance on histopathology and CLI was assessed.

Ergebnisse/Results:

CLI was used in five patients after preoperative injection of 144 ± 39 MBq (mean ± standard deviation, range: 95 – 202 MBq) 68Ga-PSMA. Intraprostatic lesions were detected by PSMA-PET/CT in 100%, positive lymph nodes could be seen in 3 of 5 patients. CLI was performed intraoperatively after a mean of 329 minutes after tracer injection. Mean background radiance of the prostate was 1441 photons/s/cm2/sr. Positive surgical margins were found in two patients based on histopathology (patient 1: pT3b, pN1, Gleason score 5+3 = 8, patient 2: pT3a, pN1, Gleason score 4+5 = 9). In these patients, elevated radiance levels were found in the tumor positive areas mean radiance: 4254 photons/s/cm2/sr.

Schlussfolgerungen/Conclusions:

68Ga-PSMA CLI seems to be a promising technique for intraoperative assessment of surgical margins in robot-assisted radical prostatectomy. A prospective trial is mandatory to elucidate further results concerning sensitivity and specificity.