PSMA-PET guided hook-wire localization of nodal metastases in prostate cancer: a targeted approach

Abstract

Prostate Specific Membrane Antigen Positron Emission Tomography/Computed Tomography (PSMA-PET/CT) has increased the sensitivity and specificity of imaging to identify metastatic prostate cancer in the group of patients with early biochemical recurrence when compared to conventional imaging. In patients who develop biochemical recurrence of prostate cancer following surgical resection, salvage lymph node dissection may reduce prostate specific antigen (PSA) levels and delay the time for commencement of systemic therapies. However, PLND may be an anatomically and technically difficult procedure, particularly with small metastatic diseases which can be problematic for intra-operative identification. We describe the technique using PSMA-PET imaging to pre-operatively localise areas of low-volume nodal metastatic disease with hookwire to allow targeted lymph node dissection with direct visualisation and palpation to ensure adequate clearance of involved nodes.

Exploring miRNA Signature and Other Potential Biomarkers for Oligometastatic Prostate Cancer Characterization: The Biological Challenge behind Clinical Practice. A Narrative Review

“…Pelvic lymph nodes are a very common site of recurrence, and lymph node dissection is an elective surgical procedure. In order to limit side effects correlated to this approach and thanks to the advent of next-generation imaging techniques, new surgical strategies are emerging, such as the use of pre-operative hook-wire localization under CT guidance of lymph node detected by PSMA PET [49].…”

PSMA-PET detected port site recurrence of prostate cancer following minimally invasive radical prostatectomy and utilisation of hookwire localisation for excision

“…In other clinical scenarios, the novel use of hook wire techniques in urological oncology during salvage pelvic lymph node dissection has been described as a means to reduce morbidity while achieving oncologic success. 6 In this article, we demonstrate the utility of this technique in minimising potential morbidity during diagnostic and potentially therapeutic excision of prostate cancer port site metastasis.…”

How to do an ultrasound or computed tomography guided hook‐wire localization excisional biopsy of non‐palpable lymph nodes

“…Outside of the breast surgery literature, the largest case series is by Park et al ., reporting eight patients whose cervical masses were excised using HWL technique under US guidance, six of whom had previously neck surgeries 1 . Under CT guidance, there have been only two case reports describing the technique to aid the excision of a pelvic node in metastatic prostate cancer, and an inguinal node in recurrent rectal cancer 2,3 …”

“…1 Under CT guidance, there have been only two case reports describing the technique to aid the excision of a pelvic node in metastatic prostate cancer, and an inguinal node in recurrent rectal cancer. 2,3 HWL must be performed on day of surgery as the wire is external to the patient. This inflexibility could affect the operating theatre work flow and efficiency.…”