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The Value of 99m Tc-PSMA SPECT/CT-Guided Surgery for Identifying and Locating Lymph Node Metastasis in Prostate Cancer Patients.
- Source :
-
Annals of surgical oncology [Ann Surg Oncol] 2019 Feb; Vol. 26 (2), pp. 653-659. Date of Electronic Publication: 2018 Oct 15. - Publication Year :
- 2019
-
Abstract
- Background: This study evaluated the effect of technetium-99m ( <superscript>99m</superscript> Tc)-labeled prostate-specific membrane antigen (PSMA)-based image-guided surgery on the oncologic outcomes for patients with primary or recurrent prostate cancer (PCa).<br />Methods: This study retrospectively analyzed 54 consecutive patients with PCa who underwent <superscript>99m</superscript> 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.<br />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.<br />Conclusions: This study showed that <superscript>99m</superscript> 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.
- Subjects :
- Aged
Follow-Up Studies
Humans
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Recurrence, Local diagnostic imaging
Neoplasm Recurrence, Local surgery
Prostatic Neoplasms diagnostic imaging
Prostatic Neoplasms surgery
Retrospective Studies
Treatment Outcome
Glutamate Carboxypeptidase II metabolism
Neoplasm Recurrence, Local pathology
Organotechnetium Compounds chemistry
Prostatic Neoplasms secondary
Single Photon Emission Computed Tomography Computed Tomography methods
Surgery, Computer-Assisted methods
Tomography, X-Ray Computed methods
Subjects
Details
- Language :
- English
- ISSN :
- 1534-4681
- Volume :
- 26
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Annals of surgical oncology
- Publication Type :
- Academic Journal
- Accession number :
- 30324468
- Full Text :
- https://doi.org/10.1245/s10434-018-6805-y