[^99mTc]Tc-PSMA-I&S: Anwendung zur Radioguided Surgery beim rezidivierten Prostatakarzinom

Zusammenfassung

Durch die verbesserte Detektionsrate hat sich die PSMA PET in den letzten Jahren zunehmend als bildgebende Standarduntersuchung beim biochemischen Rezidiv eines Prostatakarzinoms etabliert. Im Falle einer limitierten regionären lymphogenen Metastasierung in der PSMA PET rückt gegenwärtig eine chirurgische Resektion im Rahmen einer Salvage-Lymphadenektomie vermehrt in den Fokus. Um hierbei die intraoperative Detektion und somit eine sichere Resektion zu erleichtern, können neue PSMA-gerichtete Radioliganden (z. B. [^99 mTc]Tc-PSMA-I&S, imaging&surgery) im Rahmen einer PSMA-radioguided surgery zum Einsatz kommen. Im vorliegenden Beitrag sollen der Ablauf, Ergebnisse sowie zukünftige Entwicklungen der Salvage-Lymphadenektomie mittels PSMA-radioguided surgery vorgestellt werden.

Abstract

Based on its superb detection rates PSMA PET became the routine imaging modality for biochemical recurrent prostate cancer within the last few years. At limited regional lymphatic spread on PSMA PET salvage lymph node dissection is currently increasingly inquired. To ensure intraoperative detection and facilitate dissection PSMA-radioguided surgery employing novel PSMA-targeted radioligands (e. g. [^99 mTc]Tc-PSMA-I&S, imaging&surgery) can be applied. This manuscript discusses the procedure, outcomes as well as future developments of salvage lymph node dissection using PSMA-radioguided.

Schlüsselwörter

Biochemisches Rezidiv - Lymphadenektomie - metastasen-direktive Therapie - PSA - PSMA - Salvage

Key words

Biochemical recurrence - lymph node dissection - metastasis-directed therapy - PSA - PSMA - salvage

Publication History

Article published online:
30 November 2020

• Referenzen

• 1 Banerjee SR, Pullambhatla M, Byun Y. et al. 68Ga-labeled inhibitors of prostate-specific membrane antigen (PSMA) for imaging prostate cancer. Journal of medicinal chemistry 2010; 53: 5333-5341
• 2 Deandreis D, Guarneri A, Ceci F. et al. (68)Ga-PSMA-11 PET/CT in recurrent hormone-sensitive prostate cancer (HSPC): a prospective single-centre study in patients eligible for salvage therapy. European journal of nuclear medicine and molecular imaging 2020
• 3 Emmett L, Tang R, Nandurkar R. et al. 3-Year Freedom from Progression After (68)Ga-PSMA PET/CT-Triaged Management in Men with Biochemical Recurrence After Radical Prostatectomy: Results of a Prospective Multicenter Trial. Journal of nuclear medicine. official publication, Society of Nuclear Medicine 2020; 61: 866-872
• 4 Fendler WP, Calais J, Eiber M. et al. Assessment of 68Ga-PSMA-11 PET Accuracy in Localizing Recurrent Prostate Cancer: A Prospective Single-Arm Clinical Trial. JAMA oncology 2019; 5: 856-863
• 5 Fendler WP, Ferdinandus J, Czernin J. et al. Impact of (68)Ga-PSMA-11 PET on the Management of recurrent Prostate Cancer in a Prospective Single-Arm Clinical Trial. Journal of nuclear medicine. official publication, Society of Nuclear Medicine 2020; Online ahead of print.
• 6 Fossati N, Suardi N, Gandaglia G. et al. Identifying the Optimal Candidate for Salvage Lymph Node Dissection for Nodal Recurrence of Prostate Cancer: Results from a Large, Multi-institutional Analysis. European urology 2019; 75: 176-183
• 7 Han S, Woo S, Kim YJ. et al. Impact of (68)Ga-PSMA PET on the Management of Patients with Prostate Cancer: A Systematic Review and Meta-analysis. European urology 2018; 74: 179-190
• 8 Hensbergen AW, Buckle T, Van Willigen DM. et al. Hybrid Tracers Based on Cyanine Backbones Targeting Prostate-Specific Membrane Antigen: Tuning Pharmacokinetic Properties and Exploring Dye-Protein Interaction. Journal of nuclear medicine. official publication, Society of Nuclear Medicine 2020; 61: 234-241
• 9 Hofman MS, Hicks RJ, Maurer T. et al. Prostate-specific Membrane Antigen PET: Clinical Utility in Prostate Cancer, Normal Patterns, Pearls, and Pitfalls. Radiographics 2018; 38: 200-217
• 10 Horn T, Krönke M, Rauscher I. et al. Single Lesion on Prostate-specific Membrane Antigen-ligand Positron Emission Tomography and Low Prostate-specific Antigen Are Prognostic Factors for a Favorable Biochemical Response to Prostate-specific Membrane Antigen-targeted Radioguided Surgery in Recurrent Prostate Cancer. European urology 2019; 76: 517-523
• 11 Jilg CA, Drendel V, Rischke HC. et al. Diagnostic Accuracy of Ga-68-HBED-CC-PSMA-Ligand-PET/CT before Salvage Lymph Node Dissection for Recurrent Prostate Cancer. Theranostics 2017; 7: 1770-1780
• 12 Knipper S, Tilki D, Mansholt J. et al. Metastases-yield and Prostate-specific Antigen Kinetics Following Salvage Lymph Node Dissection for Prostate Cancer: A Comparison Between Conventional Surgical Approach and Prostate-specific Membrane Antigen-radioguided Surgery. Eur Urol Focus 2019; 05: 50-53
• 13 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF). Interdisziplinäre Leitlinie der Qualität S3 zur Früherkennung, Diagnose und Therapie der verschiedenen Stadien des Prostatakarzinoms, Langversion 5.1, 2019, AWMF Registernummer: 043/022OL. http://www.leitlinienprogramm-onkologie.de/leitlinien/prostatakarzinom/ (abgerufen am: 15.05.2020)
• 14 Maurer T, Gschwend JE, Rauscher I. et al. Diagnostic Efficacy of (68)Gallium-PSMA Positron Emission Tomography Compared to Conventional Imaging for Lymph Node Staging of 130 Consecutive Patients with Intermediate to High Risk Prostate Cancer. J Urol 2016; 195: 1436-1443
• 15 Maurer T, Hadaschik B, Budaus L. et al. PSA increase after definitive treatment. Urologe A 2019; 58: 569-582
• 16 Maurer T, Robu S, Schottelius M. et al. (99m)Technetium-based Prostate-specific Membrane Antigen-radioguided Surgery in Recurrent Prostate Cancer. European urology 2019; 75: 659-666
• 17 Maurer T, Schwamborn K, Schottelius M. et al. PSMA Theranostics Using PET and Subsequent Radioguided Surgery in Recurrent Prostate Cancer. Clin Genitourin Cancer 2016; 14: e549-e552
• 18 Maurer T, Weirich G, Schottelius M. et al. Prostate-specific membrane antigen-radioguided surgery for metastatic lymph nodes in prostate cancer. European urology 2015; 68: 530-534
• 19 Meershoek P, Van Oosterom MN, Simon H. et al. Robot-assisted laparoscopic surgery using DROP-IN radioguidance: first-in-human translation. European journal of nuclear medicine and molecular imaging 2019; 46: 49-53
• 20 Mottet N, Cornford P, Van Den Bergh RCN. et al. EAU - ESTRO - ESUR - SIOG Guidelines on prostate cancer. 2020 https://uroweb.org/guideline/prostate-cancer/ (abgerufen am 10.07.2020)
• 21 Palma DA, Olson R, Harrow S. et al. Stereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastatic Cancers: Long-Term Results of the SABR-COMET Phase II Randomized Trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2020; JCO2000818 Online ahead of print.
• 22 Rauscher I, Duwel C, Wirtz M. et al. Value of (111) In-prostate-specific membrane antigen (PSMA)-radioguided surgery for salvage lymphadenectomy in recurrent prostate cancer: correlation with histopathology and clinical follow-up. BJU Int 2017; 120: 40-47
• 23 Rauscher I, Maurer T, Souvatzoglou M. et al. Intrapatient Comparison of 111In-PSMA I&T SPECT/CT and Hybrid 68Ga-HBED-CC PSMA PET in Patients With Early Recurrent Prostate Cancer. Clinical nuclear medicine 2016; 41: e397-402
• 24 Rischpler C, Beck TI, Okamoto S. et al. (68)Ga-PSMA-HBED-CC Uptake in Cervical, Celiac, and Sacral Ganglia as an Important Pitfall in Prostate Cancer PET Imaging. Journal of nuclear medicine : official publication, Society of Nuclear Medicine 2018; 59: 1406-1411
• 25 Roach PJ, Francis R, Emmett L. et al. The Impact of (68)Ga-PSMA PET/CT on Management Intent in Prostate Cancer: Results of an Australian Prospective Multicenter Study. Journal of nuclear medicine : official publication, Society of Nuclear Medicine 2018; 59: 82-88
• 26 Robu S, Schottelius M, Eiber M. et al. Preclinical Evaluation and First Patient Application of 99mTc-PSMA-I&S for SPECT Imaging and Radioguided Surgery in Prostate Cancer. Journal of nuclear medicine : official publication, Society of Nuclear Medicine 2017; 58: 235-242
• 27 Schottelius M, Wirtz M, Eiber M. et al. [(111)In]PSMA-I&T: expanding the spectrum of PSMA-I&T applications towards SPECT and radioguided surgery. EJNMMI research 2015; 5: 68
• 28 Van Leeuwen FWB, Van Oosterom MN, Meershoek P. et al. Minimal-Invasive Robot-Assisted Image-Guided Resection of Prostate-Specific Membrane Antigen-Positive Lymph Nodes in Recurrent Prostate Cancer. Clinical nuclear medicine 2019; 44: 580-581
• 29 Van Oosterom MN, Rietbergen DDD, Welling MM. et al. Recent advances in nuclear and hybrid detection modalities for image-guided surgery. Expert review of medical devices 2019; 16: 711-734
• 30 Weineisen M, Schottelius M, Simecek J. et al. 68Ga- and 177Lu-Labeled PSMA I&T: Optimization of a PSMA-Targeted Theranostic Concept and First Proof-of-Concept Human Studies. Journal of nuclear medicine : official publication, Society of Nuclear Medicine 2015; 56: 1169-1176
• 31 Werner P, Neumann C, Eiber M. et al. [(99cm)Tc]Tc-PSMA-I&S-SPECT/CT: experience in prostate cancer imaging in an outpatient center. EJNMMI research 2020; 10: 45