Prostate-specific membrane antigen radioguided surgery with negative histopathology: an in-depth analysis

Radioguided surgery for lymph node metastases in prostate cancer

PURPOSE OF REVIEW

This review highlights recent advancements in radioguided surgery (RGS) for prostate cancer. Our objective is to provide expert insights into the state of research, as reflected in the selected articles, and to offer perspectives on the clinical implications and future directions that emerge from this rapidly evolving domain.

RECENT FINDINGS

Key findings include the potential of PSMA-RGS surgery to improve the detection of lymph node invasion in primary prostate cancer, to guide successful removal of metastatic lesions in oligorecurrent patients with acceptable complications, and the feasibility of robot-assisted PSMA-RGS using a miniaturized gamma probe. Additionally, the development of novel PSMA ligands and the integration of fluorescence imaging offer promising improvements in imaging and surgical guidance.

SUMMARY

PSMA-RGS is an emerging approach that shows promise for improving lymph node assessment and treatment outcomes in prostate cancer. However, its effect on cancer-specific as well as overall survival are still being investigated, and PSMA-targeted surgery remains an area of active research.

Prostate-specific membrane antigen-targeted surgery in prostate cancer: Accurate identification, real-time diagnosis, and precise resection

Radical prostatectomy (RP) combined with pelvic lymph node dissection (PLND) is the first step in multimodal treatment of prostate cancer (PCa) without distant metastases. For a long time, the surgical resection range has been highly dependent on the surgeon's visualization and experience with preoperative imaging. With the rapid development of prostate-specific membrane antigen positron emission tomography and single-photon emission computed tomography (PSMA-PET and PSMA-SPECT), PSMA-targeted surgery has been introduced for a more accurate pathological diagnosis and complete resection of positive surgical margins (PSMs) and micro-lymph node metastases (LNMs). We reviewed PSMA-targeted surgeries, including PSMA-PET-guided prostatic biopsy (PSMA-TB), PSMA-targeted radio-guided surgery (PSMA-RGS), PSMA-targeted fluorescence-guided surgery (PSMA-FGS), and multi-modality/multi-targeted PSMA-targeted surgery. We also discuss the strengths and challenges of PSMA-targeted surgery, and propose that PSMA-targeted surgery could be a great addition to existing surgery protocols, thereby improving the accuracy and convenience of surgery for primary and recurrent PCa in the near future.