Robot-assisted PSMA-radioguided Surgery to Assess Surgical Margins and Nodal Metastases in Prostate Cancer Patients: Report on Three Cases Using an Intraoperative PET-CT Specimen Imager

• Published in: Urology (Ridgewood, N.J.) Vol. 182; pp. e257 - e261
• Main Authors: Oderda, Marco, Grimaldi, Serena, Rovera, Guido, Delsedime, Luisa, D'Agate, Daniele, Lavagno, Federico, Marquis, Alessandro, Marra, Giancarlo, Molinaro, Luca, Deandreis, Desireé, Gontero, Paolo
• Format: Journal Article
• Language: English
• Published: United States 01-12-2023
• Subjects: Feasibility Studies; Gallium Radioisotopes; Humans; Lymph Node Excision; Male; Margins of Excision; Positron Emission Tomography Computed Tomography - methods; Prostatectomy; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Robotic Surgical Procedures; Robotics
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2023.08.013

The aim of this feasibility study was to test the intraoperative use of this brand-new specimen PET/CT to guide robot-assisted radical prostatectomy and pelvic lymph node dissection.
Three cases of robot-assisted radical prostatectomy and pelvic lymph node dissection were performed with intraoperative use of the specimen imager. Surgeries were performed with Da Vinci Xi robot. An intravenous injection of
Ga-PSMA-11 was performed in the OR and after complete excision, the specimens were analyzed with the imager.
The average nodal yield was 17.3 (5.8 SD) nodes per patient. Specimen PET/CT images showed a focal uptake in a metastatic node (TBR 13.6), and no uptake or diffuse, faint uptake in negative nodes (TBR range: 1-5.3). The specimen imager provided intraoperative PET/CT images that clearly showed negative surgical margins in two patients, whereas the results were uncertain in a locally advanced case.
The intraoperative use of the specimen PET/CT imager is safe and feasible and could improve the evaluation of prostate surgical margins and lymph node status.