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Related Experiment Video

Updated: May 16, 2025

Focal Laser Ablation of Prostate Cancer: An Office Procedure
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Radioguided Surgery for Prostate Cancer.

Leonardo Quarta1, Armando Stabile1, Arturo Chiti2

  • 1Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.

European Urology Focus
|May 14, 2025
PubMed
Summary

Prostate-specific membrane antigen radioguided surgery (PSMA-RGS) aids in identifying lymph node metastases during prostate cancer surgery. While safe and accurate for larger metastases, its sensitivity for micrometastatic disease requires further investigation.

Keywords:
Lymph node dissectionLymph node metastasisProstate cancerProstate-specific membrane antigenRadioguided surgery

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Area of Science:

  • Oncology
  • Surgical Innovation
  • Nuclear Medicine

Background:

  • Prostate cancer (PC) management relies on accurate staging and detection of lymph node metastases (LNMs).
  • Prostate-specific membrane antigen (PSMA) is a validated target for PC imaging and therapy.
  • Emerging techniques aim to improve intraoperative detection of LNMs.

Purpose of the Study:

  • To evaluate the safety, feasibility, and accuracy of PSMA-RGS for intraoperative LNM detection in PC.
  • To compare PSMA-RGS performance with preoperative imaging in the primary setting.
  • To assess the potential of PSMA-RGS in improving surgical outcomes for PC patients.

Main Methods:

  • PSMA-RGS utilizes PSMA ligands labeled with radionuclides emitting gamma or beta particles for real-time surgical guidance.
  • Application in salvage lymph node dissection for biochemical recurrence and extended pelvic lymph node dissection in the primary setting.
  • Intraoperative use of a gamma probe for detecting radioactive signals from PSMA-positive LNMs.

Main Results:

  • PSMA-RGS demonstrated high specificity and positive predictive value in identifying LNMs.
  • The technique is safe and feasible for both salvage and primary lymph node dissection.
  • PSMA-RGS showed superior accuracy compared to preoperative PSMA positron emission tomography in the primary setting.
  • Sensitivity for micrometastatic disease remains a limitation due to probe spatial resolution.

Conclusions:

  • PSMA-RGS is a promising tool for enhancing surgical accuracy in prostate cancer by providing real-time intraoperative guidance.
  • The technique shows potential for optimizing surgical management, particularly in identifying larger metastatic lymph nodes.
  • Further research with long-term follow-up is necessary to refine detection strategies and confirm the oncological impact of PSMA-RGS.