Clinical Responses to Prostate-specific Membrane Antigen Radioguided Salvage Lymphadenectomy for Prostate Cancer Recurrence: Results from a Prospective Exploratory Trial

Adam B. Weiner; Zachary Ells; Catherine Meyer; Magnus Dahlbom; David Sennung; Deepu Varughese; Vinicius B. Ludwig; Giuseppe Carlucci; Raeven Grant; Johannes Czernin; Jeremie Calais; Robert E. Reiter

European Urology Open Science (Dec 2024)

Clinical Responses to Prostate-specific Membrane Antigen Radioguided Salvage Lymphadenectomy for Prostate Cancer Recurrence: Results from a Prospective Exploratory Trial

Adam B. Weiner,
Zachary Ells,
Catherine Meyer,
Magnus Dahlbom,
David Sennung,
Deepu Varughese,
Vinicius B. Ludwig,
Giuseppe Carlucci,
Raeven Grant,
Johannes Czernin,
Jeremie Calais,
Robert E. Reiter

Affiliations

Adam B. Weiner: Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA; Institute for Precision Health, University of California-Los Angeles, Los Angeles, CA, USA; Corresponding author. 300 Stein Plaza, Third Floor, Los Angeles, CA 90024, USA. Tel. +1 209 483 6880; Fax: +1 310 794 7700.
Zachary Ells: Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
Catherine Meyer: Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
Magnus Dahlbom: Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
David Sennung: Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
Deepu Varughese: Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
Vinicius B. Ludwig: Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
Giuseppe Carlucci: Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
Raeven Grant: Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
Johannes Czernin: Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
Jeremie Calais: Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
Robert E. Reiter: Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, CA, USA

Journal volume & issue: Vol. 70
pp. 36 – 42

Abstract

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Background and objective: Prostate-specific membrane antigen (PSMA) radioguided salvage pelvic lymph node dissection (S-PLND) has emerged as a feasible treatment option for prostate cancer recurrence following initial surgery. This study aims to evaluate the feasibility and short-term outcomes of PSMA radioguided S-PLND. Methods: From a prospective trial of 99mTc-PSMA-I&S followed by PSMA radioguided robotic surgery, we evaluated patients treated for node-only recurrence following radical therapy. The primary outcome was serum prostate-specific antigen (PSA) response 3 mo after surgery. Key findings and limitations: Among 14 patients (enrolled from June 2021 to June 2023), the median age was 65 yr. One patient had undergone primary whole gland ultrasound ablation, while the rest received prior prostatectomy. The median (interquartile range) time from primary treatment to PSMA positron emission tomography (PET) was 4.1 (2.9–8.3) yr, and 21 total pelvic targets were noted on PSMA PET: one in eight patients (67%), two in five patients (29%), and three in one patient (7%). Targets were successfully detected intraoperatively and removed in 13/14 (93%) patients. Cancer was noted on histopathology in 90% (19/21) of PSMA PET targets, 94% (17/18) of single-photon emission computed tomography targets, and 82% (14/17) of gamma probe targets. There were no adverse effects due to the radiotracer, and there were no complications after surgery. PSA at 3 mo was <0.2 ng/ml in two (14%) patients, and a ≥50% decline was noted in five (36%) patients. After a mean follow-up of 8.3 mo, the median time to next treatment was 11.7 mo, which was noted in nine patients. Conclusions and clinical implications: PSMA radioguided S-PLND is feasible and safe. However, the clinical role and the honing of technique and patient selection will be required in prospective studies. Patient summary: In 14 patients who had prostate cancer recurrence after their initial treatment, performing surgery using radioactive tags to location is possible. However, futures studies are still needed to improve the technique.

Published in European Urology Open Science

ISSN: 2666-1683 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the genitourinary system. Urology; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.journals.elsevier.com/european-urology-open-science

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