First-in-man intraoperative Cerenkov luminescence imaging for oligometastatic prostate cancer using ⁶⁸Ga-PSMA-11

Excerpt

For high-risk prostate cancer (PC), extended pelvic lymph node dissection (ePLND) is recommended in addition to radical prostatectomy (RP) [1]. However, many lymph node metastases are located outside the standard ePLND field and contribute to early relapses [2, 3]. Therefore, the surgical template should be adjusted to findings on preoperative imaging. Cerenkov luminescence imaging (CLI) in breast cancer surgery proved to be feasible and promising [4]. We report on the first-in-man CLI findings in a 68-year-old oligometastatic patient undergoing RP and ePLND. A 116-MBq ⁶⁸Ga-PSMA was administered 234 min before intraoperative imaging. One lymph node metastasis in the right pelvis was detected by both preoperative mpMRI and ⁶⁸Ga-PSMA-11 PET/CT (A, arrow). PC in the right prostate lobe demonstrated focal ⁶⁸Ga-PSMA-11 uptake (B, arrow). CLI of the prostate specimen revealed no cancer tissue close to the surface (C = prostate base and ventral side). The suspicious lymph node was resected en-bloc with adjacent tissue. Besides one macroscopic lymph node metastasis, two different nodes were palpable (D, arrows). In CLI, two lesions showed high (E, arrows) and one mildly elevated intensity levels (E, star). Intraoperative frozen section diagnosed only one metastasis, but final histopathology proved the presence of two cancer-positive lymph nodes pT2b, pN1 (2/17), R0, and ISUP-GG 3. PSMA expression by immunohistochemistry was strong in the 2 positive and weak and focal in the negative lymph node with fatty metaplasia. Representative H&E (F) and PSMA immunohistochemistry (G) are shown. …