The Value of 99mTc-PSMA SPECT/CT-Guided Surgery for Identifying and Locating Lymph Node Metastasis in Prostate Cancer Patients

Su, Heng; Zhu, Yao; Hu, Sunli; Liu, Chang; Lin, Guorong; Dai, Bo; Zhang, Ying Jian; Ye, Ding Wei

doi:10.1245/s10434-018-6805-y

Cited by 15 publications

(80 citation statements)

References 21 publications

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“…Another therapeutic possibility is the surgical resection of the recurrent lesion: However, surgery after primary PC resection or radiotherapy is very difficult, technically challenging, and associated with significant morbidity. Currently, there are some studies describing a new technique for surgical resection of recurrent PC lesions by means of PSMA‐radioguided surgery 9,28 . This new technique helps to localize any metastatic lesion or local recurrence of PC during salvage surgery.…”

Section: Discussionmentioning

confidence: 99%

Single‐fraction image‐guided robotic radiosurgery efficiently controls local prostate cancer recurrence after radical prostatectomy

et al. 2020

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Purpose To assess the therapeutic potential of single‐fraction robotic stereotactic ablative body radiotherapy (SABR) in patients with locally recurrent prostate cancer (PC) after radical prostatectomy (RP). Materials and methods We included 35 patients with biochemical failure after RP with single‐site local recurrence in the prostate bed diagnosed by PSMA PET/CT. About 20/35 pts had previously received post‐surgical adjuvant radiation therapy. High‐resolution multiparametric magnetic resonance imaging (mpMRI) for exact visualization of tumor tissue was performed at 1.5 (n = 23; Siemens Magnetom Aera) or 3 Tesla (n = 12; Siemens Magnetom VIDA, Siemens Healthineers, Erlangen, Germany). Using the MRI and PET/CT dataset for planning, SABR was carried out after ultrasound‐guided placement of a single gold fiducial marker at the site of tumor recurrence using a CyberKnife M6 unit (Accuray Inc., Sunnyvale, USA). Due to the high diagnostic accuracy of PSMA PET/CT and mpMRI, pre‐SABR biopsy of tumor tissue was not deemed necessary. PSMA PET/CT performed in median 88 days before SABR confirmed the absence of distant metastases. MpMRI was performed at a median of 22 days prior to the intervention. SABR was performed in a single fraction with a dose of 20 (5/35), 21 (27/35) or 22 (3/35) Gy. Follow‐up serum PSA was measured every 3 months thereafter. Results Median patient age was 72 years (57‐80 years) and median time from RP to SABR was 96.8 months (IQR, 69.3‐160.2). Median serum PSA before SABR was 1.38 ng/mL (IQR 0.75‐2.72). At 3 months, median PSA had dropped significantly in 27/35 patients to a median of 0.35 ng/mL (IQR 0.25‐0.68). At 6 months, 30/35 patients showed biochemical response to SABR, while five patients were progressing: three had systemic disease on PSMA PET/CT, while two patients had rising PSA values without a visible correlate on PET/CT. The median follow‐up time was 16 months. Grade 1 genitourinary (GU) toxicity was reported in 3/35 patients (9%) and grade 1 gastrointestinal (GI) toxicity in 2/35 patients (6%), respectively. Conclusion SABR is an efficient new treatment option in the management of single‐site local recurrent PC without the evidence of systemic disease; due to its very low toxicity, it is an alternative to surgical re‐treatment or other focal therapies. It can significantly delay the onset of androgen deprivation therapy (ADT) in biochemical failure after radical prostatectomy.

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Section: Discussionmentioning

confidence: 99%

Single‐fraction image‐guided robotic radiosurgery efficiently controls local prostate cancer recurrence after radical prostatectomy

et al. 2020

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“…These components optimize the pharmacokinetic properties, leading to a high internalization ratio and consequently high PET image contrast (24)(25)(26). However, none of these tracers can form stable complexes with 64 Cu or 67 Cu. Despite the high labeling yields of PSMA-617 with 64 Cu in vitro (.99%), a poor in vivo stability with high liver uptake was observed (27,28).…”

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confidence: 99%

“…However, none of these tracers can form stable complexes with 64 Cu or 67 Cu. Despite the high labeling yields of PSMA-617 with 64 Cu in vitro (.99%), a poor in vivo stability with high liver uptake was observed (27,28).…”

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confidence: 99%

“…The pair 64 Cu/ 67 Cu is a seamless theranostic match. Because of its favorable properties, 64 Cu is ideally suited for long-term PET imaging and allows the dosimetry of tracers labeled with 67 Cu to be determined. The therapeutic nuclide 67 Cu may be cyclotronproduced and thus available for good-manufacturing-practice production.…”

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confidence: 99%

“…The therapeutic nuclide 67 Cu may be cyclotronproduced and thus available for good-manufacturing-practice production. 64 Cu has been shown to be an attractive radionuclide for PET imaging, and a series of PSMA-binding tracers has been described by the Pomper group (29). Further examples of previous publications that describe copper-labeled radiotracers for the targeting of PSMA-expressing tumors are 64 Cu-NODAGA-PSMA and 64 Cu-ABN-1.…”

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Development of Novel PSMA Ligands for Imaging and Therapy with Copper Isotopes

et al. 2019

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Prostate-specific membrane antigen (PSMA)-binding tracers have been shown to be promising agents for the specific targeting of prostate tumors. On labeling with the short-lived isotopes 18 F and 68 Ga, excellent molecular imaging performance is achieved. This potential could be further exploited using long-lived isotopes. Because of the favorable half-life of 64 Cu, tracers labeled with this PET nuclide could solve logistic problems. Moreover, this isotope provides a theranostic pair with the therapeutic copper isotope 67 Cu. Hence, 9 novel tracers that combine dedicated copper chelators with the PSMA-specific urea-based binding motif were developed. Methods: The precursors were obtained by solid-phase synthesis. The purity and molecular weight of the PSMA ligands were confirmed by high-performance liquid chromatography and liquid chromatography-mass spectrometry. The compounds were labeled with 64 Cu, with a radiolabeling yield of more than 99%. Competitive cell binding assays and internalization assays were performed with C4-2 cells, a subline of the PSMA-positive cell line LNCaP (human lymph node carcinoma of the prostate). In vitro serum stability, the stability of 64 Cu-CA003 in blood, and the in vivo fate of neat 64 Cuchloride or 64 Cu-CA003 were determined to prove whether the stability of the radiolabeled compounds is sufficient to ensure no significant loss of copper during the targeting process. For PET imaging and biodistribution studies, a C4-2 tumor-bearing mouse model was used. Results: The radiolabeled 64 Cu-PSMA ligands showed high serum stability. All PSMA ligands showed high inhibition potencies, with equilibrium inhibition constants in the low nanomolar range. 64 Cu-CA003 and 64 Cu-CA005 showed high internalization ratios (34.6% ± 2.8 and 18.6% ± 4.4, respectively). Both the in vitro serum stability determination and the in vivo characterization of the main radiolabeled compounds confirmed that, except for 64 Cu-PSMA-617, all compounds showed high serum stability within the observation period of 24 h. Small-animal PET imaging demonstrated high tumor uptake within 20 min. Organ distribution studies confirmed high specific uptake in the tumor, with 30.8 ± 12.6 percentage injected dose (%ID)/g at 1 h after injection. Rapid clearance from the kidneys was observed-a decrease from 67.0 ± 20.9 %ID/g at 1 h after injection to 7.5 ± 8.51 %ID/g at 24 h after injection (in the case of CA003). The performance of CA003, the compound with the best preclinical properties, was assessed in a first patient. In line with its preclinical data, PET imaging resulted in clear visualization of the cancer lesions, with high contrast. Conclusion: The 64 Culabeled PSMA ligands are promising agents to target PSMA and visualize PSMA-positive tumor lesions as shown in preclinical evaluation by small-animal PET studies, organ distribution, and a patient application. Most importantly, the images obtained at 20 h enabled delineation of unclear lesions, showing that the compounds fulfill the prerequisite for dosimetry in the co...

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99mTc-PSMA targeted robot-assisted radioguided surgery during radical prostatectomy and extended lymph node dissection of prostate cancer patients

Yılmaz¹,

Şahin

Ergül³

et al. 2022

Ann Nucl Med

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The Value of 99mTc-PSMA SPECT/CT-Guided Surgery for Identifying and Locating Lymph Node Metastasis in Prostate Cancer Patients

Cited by 15 publications

References 21 publications

Single‐fraction image‐guided robotic radiosurgery efficiently controls local prostate cancer recurrence after radical prostatectomy

Single‐fraction image‐guided robotic radiosurgery efficiently controls local prostate cancer recurrence after radical prostatectomy

Development of Novel PSMA Ligands for Imaging and Therapy with Copper Isotopes

99mTc-PSMA targeted robot-assisted radioguided surgery during radical prostatectomy and extended lymph node dissection of prostate cancer patients

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