2024-04-04 14:33:32
In patients with newly diagnosed prostate cancer, lymph node involvement is correlated with the risk of recurrence. Identifying the presence of lymph node metastases is crucial for clinical decision making and treatment planning. For example, patients with node-positive disease may benefit from adjuvant treatments, such as radiotherapy and chemotherapy, which can improve outcomes.
Radio-guided surgery, by targeting prostate-specific membrane antigen (PSMA), a glycoprotein involved in numerous pathologies and overexpressed in most patients with prostate cancer, already makes it possible to identify the stage of spread and cancer metastasis, which allows a more appropriate therapeutic decision.
Optimize lymph node staging and treatment
Currently, extended pelvic lymph node dissection (eCGP), a procedure in which as many metastatic lymph nodes as possible are removed from the pelvic region, is considered the best tool for lymph node staging. Although the therapeutic effect of this procedure remains debated, evidence suggests that eliminating all lymph node metastases allows for optimal disease control.
One of the lead authors, Dr. Diederik M. Somford, urologist at Canisius Wilhelmina Hospital (Nijmegen, Netherlands) specifies that “radio-guided surgery by PSMA – which uses radiotraceurs that bind to metastases present in the lymph nodes – can help the surgeon to accurately locate and remove all metastatic lymph nodes in patients with prostate cancer. This technique notably makes it possible to detect positive lymph nodes outside the standard pelvic surgical area, or in difficult to access regions, which would otherwise have been missed.”
The study conducted on 20 patients with recently diagnosed prostate cancer, with at least one suggestive lymph node visible on PET scan and who underwent PSMA radioguided surgery to locate and remove metastatic lymph nodes,
- confirms the feasibility, effectiveness and safety and feasibility of the surgery as well as its accuracy in determining metastatic lymph nodes.
- no adverse events related to radio-guided surgery were reported;
- radio-guided surgery identified and removed 29 of 49 lesions, of which 28 (97%) had lymph node metastases;
- Another 14 out of 49 (29%) removed lymph nodes were not detected during radio-guided surgery and 2 of them had metastases.
This is one of the first trials to confirm the overall effectiveness of the technique in patients recently diagnosed with prostate cancer, the researchers conclude.
“The current results demonstrate the great potential of radio-guided surgery
in prostate cancer and highlight the growing role of molecular imaging and tracers in the operating room.
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