Robot-assisted prostate-specific membrane antigen-radioguided salvage surgery in recurrent prostate cancer using a DROP-IN gamma probe: the first prospective feasibility study

Barros, H.A. de; Oosterom, M.N. van; Donswijk, M.L.; Hendrikx, J.J.M.A.; Vis, A.N.; Maurer, T.; ... ; Leeuwen, P.J. van (2022)

Article / Letter to editor

Background: It has been proven that intraoperative prostate-specific membrane antigen (PSMA)-targeted radioguidance is valuable for the detection of prostate cancer (PCa) lesions during open surgery. Rapid extension of robot-assisted, minimally invasive surgery has increased the need to make PSMA-radioguided surgery (RGS) robot-compliant.Objective: To evaluate whether the miniaturized DROP-IN gamma probe facilitates translation of PSMA-RGS to robotic surgery in men with recurrent PCa.Design, setting, and participants: This prospective feasibility study included 20 patients with up to three pelvic PCa recurrences (nodal or local) on staging PSMA positron emission tomography (PET) after previous curative-intent therapy.Surgical procedure: Robot-assisted PSMA-RGS using the DROP-IN gamma probe was carried out 19-23 h after intravenous injection of (99m)technetium PSMA-Investigation & Surgery (Tc-99m-PSMA-I&S).Measurements: The primary endpoint was the feasibility of robot-assisted PSMA-RGS. Secondary endpoints were a comparison of the radioactive status (positive or negative) of resected specimens and final histopathology results, prostate-specific antigen (PSA) response following PSMA-RGS, and complications according to the Clavien-Dindo classification.Results and limitations: Using the DROP-IN probe, 19/21 (90%) PSMA-avid lesions could be resected robotically. On a per-lesion basis, the sensitivity and specificity of robot-assisted PSMA-RGS was 86% and 100%, respectively. A prostate-specific antigen (PSA) reduction of >50% and a complete biochemical response (PSA <0.2 ng/ml) were seen in 12/18 (67%) and 4/18 (22%) patients, respectively. During follow-up of up to 15 mo,* Corresponding author. Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam 1066 CX, The Netherlands. Tel. [phone]. E-mail address: [e-mail] (H.A. de Barros)

• Prostate cancer
• Prostate-specific membrane
• antigen
• Image-guided surgery
• Radioguided surgery
• Robot-assisted surgery

• All authors: Barros, H.A. de; Oosterom, M.N. van; Donswijk, M.L.; Hendrikx, J.J.M.A.; Vis, A.N.; Maurer, T.; Leeuwen, F.W.B. van; Poel, H.G. van der; Leeuwen, P.J. van
• Date: 2022-06-09
• Journal: European Urology
• Volume: 82
• Issue: 1
• Pages: 97 - 105
• DOI: doi:10.1016/j.eururo.2022.03.002
• Link: https://www.sciencedirect.com/science/article/pii/S0302283822016724?via%...