According to a first-in-human study published in the October issue of the Journal of Nuclear Medicine, a new intraoperative imaging technology called Cerenkov luminescence imaging (CLI) can accurately measure surgical margins during radical prostatectomy.
According to the feasibility study, 68Ga-PSMA CLI can photograph the entire excised prostate specimen’s surface in order to detect prostate cancer tissue at the resection margin.
For men with localized prostate cancer, radical prostatectomy is one of the most common treatment options. A radical prostatectomy aims to thoroughly resect the prostate with no visible surgical margins.
It linked incomplete removal of cancer tissue following radical prostatectomy to worse patient outcomes, such as a higher risk of recurrence and prostate cancer-related mortality.
PSMA ligand positron emission tomography (PET) has emerged as an accurate technique for detecting prostate cancer, both in primary staging and at the time of biochemical recurrence.
Researchers wanted to see if CLI might be used to identify prostate cancer because PET imaging agents release optical photons through a phenomenon known as Cerenkov luminescence.
“Intraoperative radioguidance with CLI may help surgeons in the detection of extracapsular extension, positive surgical margins, and lymph node metastases with the aim of increasing surgical precision,” stated Christopher Darr, PhD, resident at the Department of Urology of the University Medical Center Essen in Essen, Germany.
“The intraoperative use of CLI would allow the examination of the entire prostate surface and provide the surgeon with real-time feedback on the resection margins.”
Ten patients with high-risk primary prostate cancer were enrolled in the single-center trial. Following 68Ga-PSMA PET scans, radical prostatectomy and intraoperative CLI of the resected prostate were conducted. The tumor-to-background ratios were determined after CLI images were evaluated postoperatively to select regions of interest based on signal intensity.
Intraoperative radioguidance with CLI may help surgeons in the detection of extracapsular extension, positive surgical margins, and lymph node metastases with the aim of increasing surgical precision. The intraoperative use of CLI would allow the examination of the entire prostate surface and provide the surgeon with real-time feedback on the resection margins.
Christopher Darr
The CLI tumor margin assessment was done by looking at the increased signals on the surface of intact prostate pictures. The tumor margin status as determined by CLI was compared to postoperative histology to measure accuracy.
On the incised prostate CLI pictures, tumor cells were successfully discovered and confirmed by histopathology. Three patients had positive surgical margins, and increased signal levels in two of them allowed for CLI diagnosis.
According to traditional histology, 25 of the 35 CLI areas of interest were able to visualize tumor signals.
Boris A. Hadaschik, PhD, director of the Clinic for Urology of the University Medical Center Essen, added, “Radical prostatectomy could achieve significantly higher accuracy and oncological safety, especially in patients with high-risk prostate cancer, through the intraoperative use of radioligands that specifically detect prostate cancer cells. In the future, a targeted resection of lymph node metastases could also be performed in this way. This new imaging combines urologists and nuclear medicine specialists in the local treatment of patients with prostate cancer.”
The authors of “Intraoperative 68Gallium-PSMA Cerenkov Luminescence Imaging for Surgical Margins in Radical Prostatectomy A Feasibility Study” include Christopher Darr, Nina N. Harke, Jan Philipp Radtke, Leubet Yirga, Claudia Kesch, and Boris A. Hadaschik, Department of Urology, University Hospital Essen, Essen, Germany; Maarten R. Grootendorst, Clinical Research, Lightpoint Medical Ltd., Chesham, United Kingdom; Wolfgang P. Fendler, Peter Fragoso Costa, Christopher Rischpler, Christine Praus, Ken Herrmann and Ina Binse; Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; Johannes Haubold, Institute of Diagnostics and Radiology, University Hospital Essen, Essen, Germany; and Henning Reis and Thomas Hager, Institute of Pathology, University of Duisburg-Essen, Essen, Germany.
This study was first made available online in February 2020, with a print version following in October 2020.
