Aktuelle Urol 2017; 48(02): 148-152
DOI: 10.1055/s-0042-120455
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

111In-PSMA-radioguided surgery beim oligometastasierten Prostatakarzinomrezidiv

PSMA-Radioguided Surgery for Salvage Lymphadenectomy in Recurrent Prostate Cancer
Isabel Rauscher
1   Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
,
Matthias Eiber
1   Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
,
Tobias Maurer
2   Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
16. Mai 2017 (online)

Zusammenfassung

Unlängst wurde die 111In-PSMA-radioguided surgery (111In-PSMA-RGS) von unserer Gruppe als neuartige und vielversprechende Technik zur gezielten Resektion beim oligometastasierten Prostatakarzinomrezidiv beschrieben. Bei diesem Verfahren kommt eine Gammasonde zum Einsatz, mit der suspekte Läsionen intraoperativ identifiziert werden können. Die Sensitivität, Spezifität und Genauigkeit der 111In-PSMA-RGS im Vergleich zur Histopathologie lag dabei bei 92,3, 93,5 und 93,1%. Zudem konnten bei der 111In-PSMA-RGS 5 zusätzliche Läsionen im Vergleich zur 68Ga-HBED-CC-PSMA PET gefunden werden. Ein PSA-Abfall >50 bzw. >90% wurde bei 24/31 bzw. 15/31 Patienten beobachtet. Bei 19/30 Patienten wurde ein PSA-Nadir <0,2 ng/ml erreicht. 10/31 Patienten erhielten eine weitere prostatakarzinomspezifische Therapie nach median 125 Tagen postoperativ. Operationsbedingte Komplikationen konnten bei 10 Patienten beobachtet werden (Clavien-Dindo Klassifikation: Grad 1 n=6, Grad 3b n=4). Zusammenfassend lässt sich sagen, dass die 111In-PSMA-RGS die intraoperative Detektion insbesondere von kleinen metastatischen Läsionen wesentlich erleichtert und so auch einen positiven Einfluss auf den weiteren Erkrankungsverlauf haben könnte. Die Identifikation geeigneter Patienten auf der Basis klinischer Parameter sowie der Ergebnisse der präoperativen 68Ga-PSMA PET ist dabei jedoch von entscheidender Bedeutung.

Abstract

Recently, the use of 111In-labeled PSMA-I&T-based radioguided surgery (111In-PSMARGS) for salvage surgery using intraoperative ex-vivo γ-probe measurements has been described by our group as a promising new and individual treatment concept in patients with localised recurrent prostate cancer (PC). 111In-PSMA-RGS allowed for the intraoperative identification of metastatic lesions with a sensitivity, specificity and accuracy of 92.3, 93.5 and 93.1%, respectively, compared to histopathology. 111In-PSMA-RGS was able to detect 5 additional lymph node metastases in 3 out of 31 patients compared to 68Ga-HBED-CC-PSMA PET. A PSA decline >50 and >90% was observed in 24/31 patients and 17/31 patients, respectively. In 19/31 patients even a complete biochemical response was observed. 10/31 patients received further PC-specific treatment after a median of 125 days following 111In-PSMA-RGS. Surgery-related complications were observed in 10 patients (Clavien-Dindo classification: grade 1 n=6, grade 3b n=4). 111In-PSMA-RGS seems to be highly valuable for the intraoperative detection of small metastatic lesions in PC patients scheduled for salvage lymphadenectomy. It allows for an exact localisation and resection of metastatic tissue during 111In-PSMA-RGS and thus is anticipated to have a beneficial influence on further disease progression. However, the identification of suitable patients on the basis of 68Ga-PSMA PET imaging and clinical parameters is critical to obtain satisfactory results.

 
  • Literatur

  • 1 Siegel R, Ma J, Zou Z. et al. Cancer statistics, 2014. CA Cancer J Clin 2014; 64: 9-29
  • 2 Freedland SJ, Presti Jr. JC, Amling CL. et al. Time trends in biochemical recurrence after radical prostatectomy: Results of the SEARCH database. Urology 2003; 61: 736-741
  • 3 Han M, Partin AW, Zahurak M. et al. Biochemical (prostate specific antigen) recurrence probability following radical prostatectomy for clinically localized prostate cancer. J Urol 2003; 169: 517-523
  • 4 Boorjian SA, Thompson RH, Tollefson MK. et al. Long-term risk of clinical progression after biochemical recurrence following radical prostatectomy: The impact of time from surgery to recurrence. Eur Urol 2011; 59: 893-899
  • 5 Mottet N, Bellmunt J, Bolla M. et al. EAU guidelines on prostate cancer. Part II: Treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol 2011; 59: 572-583
  • 6 Suardi N, Gandaglia G, Gallina A. et al. Long-term outcomes of salvage lymph node dissection for clinically recurrent prostate cancer: Results of a single-institution series with a minimum follow-up of 5 years. Eur Urol 2015; 67: 299-309
  • 7 Abdollah F, Briganti A, Montorsi F. et al. Contemporary role of salvage lymphadenectomy in patients with recurrence following radical prostatectomy. Eur Urol 2015; 67: 839-849
  • 8 Umbehr MH, Muntener M, Hany T. et al. The role of 11C-Choline and 18F-Fluorocholine Positron Emission Tomography (PET) and PET/CT in prostate cancer: A systematic review and meta-analysis. Eur Urol 2013; 64: 106-117
  • 9 Evangelista L, Guttilla A, Zattoni F. et al. Utility of choline positron emission tomography/computed tomography for lymph node involvement identification in intermediate- to high-risk prostate cancer: A systematic literature review and meta-analysis. Eur Urol 2013; 63: 1040-1048
  • 10 Eiber M, Maurer T, Souvatzoglou M. et al. Evaluation of hybrid (6)(8)Ga-PSMA ligand PET/CT in 248 patients with biochemical recurrence after radical prostatectomy. J Nucl Med 2015; 56: 668-674
  • 11 Afshar-Oromieh A, Zechmann CM, Malcher A. et al. Comparison of PET imaging with a (68)Ga-labelled PSMA ligand and (18)F-choline-based PET/CT for the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging 2014; 41: 11-20
  • 12 Morigi JJ, Stricker PD, van Leeuwen PJ. et al. Prospective comparison of 18F-Fluoromethylcholine versus 68Ga-PSMA PET/CT in prostate cancer patients who have rising PSA after curative treatment and are being considered for targeted therapy. J Nucl Med 2015; 56: 1185-1190
  • 13 Afshar-Oromieh A, Avtzi E, Giesel FL. et al. The diagnostic value of PET/CT imaging with the (68)Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging 2015; 42: 197-209
  • 14 Maurer T, Weirich G, Schottelius M. et al. Prostate-specific membrane antigen-radioguided surgery for metastatic lymph nodes in prostate cancer. Eur Urol 2015; 68: 530-534
  • 15 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
  • 16 Rauscher I, Duewel 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. https://www.ncbi.nlm.nih.gov/pubmed/27862863 BJU Int 2016; Nov 10 DOI: doi: 10.1111/bju.13713. [Epub ahead of print]
  • 17 Heidenreich A, Moul JW, Shariat S. et al. Role of salvage lymph node dissection in prostate cancer. Curr Opin Urol 2016; 26: 581-589
  • 18 Rigatti P, Suardi N, Briganti A. et al. Pelvic/retroperitoneal salvage lymph node dissection for patients treated with radical prostatectomy with biochemical recurrence and nodal recurrence detected by [11C]choline positron emission tomography/computed tomography. Eur Urol 2011; 60: 935-943
  • 19 Rauscher I, Duewel 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 https://www.ncbi.nlm.nih.gov/pubmed/27862863, BJU Int. 2016 Nov 10. doi: 10.1111/bju.13713. [Epub ahead of print]
  • 20 Jilg CA, Rischke HC, Reske SN. et al. Salvage lymph node dissection with adjuvant radiotherapy for nodal recurrence of prostate cancer. J Urol 2012; 188: 2190-2197
  • 21 Rischke HC, Schultze-Seemann W, Wieser G. et al. Adjuvant radiotherapy after salvage lymph node dissection because of nodal relapse of prostate cancer versus salvage lymph node dissection only. Strahlenther Onkol 2015; 191: 310-320
  • 22 Suardi N, Gandaglia G, Gallina A. et al. Long-term outcomes of salvage lymph node dissection for clinically recurrent prostate cancer: Results of a single-institution series with a minimum follow-up of 5 years. Eur Urol 2015; 67: 299-309