PD29-01 THE VALUE OF 99MTC-PSMA SPECT/CT GUIDED SURGERY TO IDENTIFY AND LOCALIZE LYMPH NODE METASTASIS FOR PROSTATE CANCER PATIENTS

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy IV1 Apr 2018PD29-01 THE VALUE OF 99MTC-PSMA SPECT/CT GUIDED SURGERY TO IDENTIFY AND LOCALIZE LYMPH NODE METASTASIS FOR PROSTATE CANCER PATIENTS Hengchuan Su Hengchuan SuHengchuan Su More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1376AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Early detection and specific localization of prostate cancer(PCa) is important for surgery planning as it is expected to improve these patients management. Prostate specific membrane antigen (PSMA) single-photonemission-computed- tomography(SPECT)/CT imaging could achieve a higher detection rate than conventional imaging modalities in PCa patients. However, few reports have compared PSMA SPECT/CT imaging to histopathology as gold standard in PCa patients. In this study, we evaluated the value of 99mTc-PSMA SPECT/CT radioguided surgery using comparison with histopathological results of dissected specimens. METHODS A total of 47 consecutive patients with PCa undergoing PSMA SPECT/CT radioguided surgery (radical prostatectomy with primary lymph node dissection(pLND) or salvage lymph node dissection(sLND)) using 99mTc-labelled PSMA ligand between September 2015 and December 2016 were retrospectively included in this study. The resected specimens were compared with findings of postoperative histological analysis. The response to the treatment were recorded during the follow-up period. RESULTS In total, metastatic lymph nodes were found in 18 patients after histopathological workup. The positive lymph nodes were located in the common ilial vessel, iliac vessel, presacral or other regions. The average short axis diameter of PSMA SPECT/CT positive lymph nodes was 0.95±0.10 cm. On a field-based analysis, the sensitivity for PSMA SPECT/CT was 70% and the specificity was 91%. On a patient-based analysis, the sensitivity was 83% and the specificity was 90%. After the surgery, prostate specific antigen(PSA) level declined in 46 patients and increased in 1 patient. During the follow-up period (range: 3-16 months), of the 14 patients who presented with pelvic metastatic lymph nodes, 12 remained biochemical response (BR) after the surgery, 1 became biochemical recurrence (BCR) following BR, and 1 never became BR. While of the 4 patients with retroperitoneal LNMs, 2 became BCR following BR, and 2 never became BR. PSMA-guided sLND delayed disease progression in 5 of 6 patients and these patients experienced a decline of PSA for about half an year. CONCLUSIONS 99mTc-PSMA SPECT/CT guided surgery in PCa patients was safe and reliable with high sensitivity and specificity. sLND may represent a more suitable approach for patients with PCa recurrence. Patients with pelvic lymph node metastasis may benefit more from PSMA SPECT/CT guided surgery than those with retroperitoneal lymph node metastasis. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e567-e568 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Hengchuan Su More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...