Precision low-dose brachytherapy of prostate cancer under PSMA-receptor molecular visualization

Abstract

Brachytherapy with implantation of micro sources based on isotope 125I is a preferred treatment for localized prostate cancer without signs of germination of the gland capsule and in the absence of signs of metastases (stage cT1-T23aN0M0). Structural imaging methods (ultrasound, computed tomography, and magnetic resonance imaging) do not have high specificity in the differential diagnosis of prostate cancer. Hybrid technologies of radiation imaging (single-photon emission computed tomography/computed tomography, positron emission tomography/computed tomography, and positron emission tomography/magnetic resonance imaging) combine the advantages of high sensitivity of cross-sectional structural imaging methods (computed tomography and magnetic resonance imaging) and high specificity of molecular imaging methods (single-photon emission computed tomography and positron emission tomography) with tumorotropic radiopharmaceuticals. In this original clinical study, based on seven observations of localized prostate cancer (Gleason 67), it was shown that the precision of low-dose brachytherapy using 125I micro sources of localized prostate carcinomas, along with targeted biopsy, can be increased using hybrid methods of PSMA-receptor molecular imaging (single-photon emission computed tomography/ computed tomography, positron emission tomography/ computed tomography). The single-photon emission computed tomography/ computed tomography method is more accessible than positron emission tomography/ computed tomography. Moreover, when coupled with cold kits (HYNIC-PSMA), it allows research within any radioisotope diagnostics laboratory equipped with single-photon emission computed tomography/ computed tomography. The innovative technology of PSMA-navigation biopsy and brachytherapy, under the control of hybrid molecular imaging, can be used in primary and recurrent cases of localized prostate cancer, increases the accuracy and reduces the traumatic nature of procedures, and increases the medical and economic efficiency of low-dose brachytherapy with 125I micro sources. Further research is needed to improve the technology and evaluate its long-term results.