The Value of 99mTc-PSMA SPECT/CT-Guided Surgery for Identifying and Locating Lymph Node Metastasis in Prostate Cancer Patients

• Published in: Annals of surgical oncology 2019-02, Vol.26 (2), p.653-659
• Main Authors: Su, Heng-chuan, Zhu, Yao, Hu, Si-long, Liu, Chang, Lin, Guo-wen, Dai, Bo, Zhang, Ying-jian, Ye, Ding-Wei
• Format: Article
• Language: English
• Subjects: Antigens; Biopsy; Cancer surgery; Computed tomography; Lymph nodes; Lymphatic system; Magnetic resonance imaging; Medicine; Medicine & Public Health; Metastases; Oncology; Patients; Prostate cancer; Prostate-specific antigen; Prostatectomy; Single photon emission computed tomography; Surgery; Surgical Oncology; Technetium; Urologic Oncology; Urological surgery
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-018-6805-y

Background This study evaluated the effect of technetium-99m ( 99m Tc)-labeled prostate-specific membrane antigen (PSMA)-based image-guided surgery on the oncologic outcomes for patients with primary or recurrent prostate cancer (PCa). Methods This study retrospectively analyzed 54 consecutive patients with PCa who underwent 99m Tc-labeled PSMA-based image-guided surgery between January 2016 and September 2017. These patients received a radical prostatectomy (RP) with pelvic lymph node dissection (PLND) or salvage lymph node dissection (sLND). The resected specimens were compared with findings of postoperative histologic analysis. The responses to the treatment were recorded during the follow-up period. Results In 31 patients, PSMA single-photon emission computerized tomography (SPECT) and computed tomography (CT) could find 52 suspicious lymph node metastases (LNMs). With the help of PSMA SPECT/CT, 12 patients with recurrence received sLND, 19 primary PCa patients received RP with extended PLND, and 23 primary PCa patients received RP with standard PLND. The findings showed that PSMA SPECT/CT could detect LNMs with high sensitivity and specificity. In six patients, PSMA SPECT/CT could find more LNMs that were not found by MRI and help to modify the extent of lymphadenectomy. At the latest follow-up evaluation, 39 patients showed a biochemical response (BR), 9 patients showed a biochemical recurrence (BCR) after BR, and 6 patients never exhibited BR. The patients who received RP with standard PLND or extended PLND had a better prostate-specific antigen (PSA) response than the patients who received sLND. The patients with pelvic LNMs also had a better PSA response than the patients with retroperitoneal LNMs. Conclusions This study showed that 99m Tc-PSMA SPECT/CT-guided surgery can remove more LNMs than conventional imaging with high sensitivity and specificity and delay disease progression in PCa patients.