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

P Fragoso Costa; C Darr; I Binse; M Grootendorst; K Herrmann; B Hadaschik; N Harke

doi:10.1055/s-0039-1683614

Nuklearmedizin - NuclearMedicine, Table of Contents

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

Authors

P Fragoso Costa

¹University Hospital Essen, Department of Nuclear Medicine, Essen
C Darr

²University Hospital Essen, Department of Urology and Urological Oncology, Essen
I Binse

¹University Hospital Essen, Department of Nuclear Medicine, Essen
M Grootendorst

³Lightpoint Medical Ltd, Clinical Research, Chesham, United Kingdom
K Herrmann

¹University Hospital Essen, Department of Nuclear Medicine, Essen
B Hadaschik

²University Hospital Essen, Department of Urology and Urological Oncology, Essen
N Harke

²University Hospital Essen, Department of Urology and Urological Oncology, Essen

Abstract

Full Text

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.