¹¹¹In-PSMA-radioguided surgery beim oligometastasierten Prostatakarzinomrezidiv

Zusammenfassung

Unlängst wurde die ¹¹¹In-PSMA-radioguided surgery (¹¹¹In-PSMA-RGS) von unserer Gruppe als neuartige und vielversprechende Technik zur gezielten Resektion beim oligometastasierten Prostatakarzinomrezidiv beschrieben. Bei diesem Verfahren kommt eine Gammasonde zum Einsatz, mit der suspekte Läsionen intraoperativ identifiziert werden können. Die Sensitivität, Spezifität und Genauigkeit der ¹¹¹In-PSMA-RGS im Vergleich zur Histopathologie lag dabei bei 92,3, 93,5 und 93,1%. Zudem konnten bei der ¹¹¹In-PSMA-RGS 5 zusätzliche Läsionen im Vergleich zur ⁶⁸Ga-HBED-CC-PSMA PET gefunden werden. Ein PSA-Abfall >50 bzw. >90% wurde bei 24/31 bzw. 15/31 Patienten beobachtet. Bei 19/30 Patienten wurde ein PSA-Nadir <0,2 ng/ml erreicht. 10/31 Patienten erhielten eine weitere prostatakarzinomspezifische Therapie nach median 125 Tagen postoperativ. Operationsbedingte Komplikationen konnten bei 10 Patienten beobachtet werden (Clavien-Dindo Klassifikation: Grad 1 n=6, Grad 3b n=4). Zusammenfassend lässt sich sagen, dass die ¹¹¹In-PSMA-RGS die intraoperative Detektion insbesondere von kleinen metastatischen Läsionen wesentlich erleichtert und so auch einen positiven Einfluss auf den weiteren Erkrankungsverlauf haben könnte. Die Identifikation geeigneter Patienten auf der Basis klinischer Parameter sowie der Ergebnisse der präoperativen ⁶⁸Ga-PSMA PET ist dabei jedoch von entscheidender Bedeutung.

Abstract

Recently, the use of ¹¹¹In-labeled PSMA-I&T-based radioguided surgery (¹¹¹In-PSMA⁻RGS) for salvage surgery using intraoperative ex-vivo γ-probe measurements has been described by our group as a promising new and individual treatment concept in patients with localised recurrent prostate cancer (PC). ¹¹¹In-PSMA-RGS allowed for the intraoperative identification of metastatic lesions with a sensitivity, specificity and accuracy of 92.3, 93.5 and 93.1%, respectively, compared to histopathology. ¹¹¹In-PSMA-RGS was able to detect 5 additional lymph node metastases in 3 out of 31 patients compared to ⁶⁸Ga-HBED-CC-PSMA PET. A PSA decline >50 and >90% was observed in 24/31 patients and 17/31 patients, respectively. In 19/31 patients even a complete biochemical response was observed. 10/31 patients received further PC-specific treatment after a median of 125 days following ¹¹¹In-PSMA-RGS. Surgery-related complications were observed in 10 patients (Clavien-Dindo classification: grade 1 n=6, grade 3b n=4). ¹¹¹In-PSMA-RGS seems to be highly valuable for the intraoperative detection of small metastatic lesions in PC patients scheduled for salvage lymphadenectomy. It allows for an exact localisation and resection of metastatic tissue during ¹¹¹In-PSMA-RGS and thus is anticipated to have a beneficial influence on further disease progression. However, the identification of suitable patients on the basis of ⁶⁸Ga-PSMA PET imaging and clinical parameters is critical to obtain satisfactory results.

Schlüsselwörter

PSMA - Salvage Operation - radioguided surgery - oligometastasiert - PSA - Prostatakarzinomrezidiv

Key words

PSMA - salvage surgery - radioguided surgery - oligometastatic - PSA - recurrent prostate cancer

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