68 Ga-PSMA Cerenkov luminescence imaging in primary prostate cancer: first-in-man series
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ORIGINAL ARTICLE
68
Ga-PSMA Cerenkov luminescence imaging in primary prostate cancer: first-in-man series Judith olde Heuvel 1,2 & Berlinda J. de Wit-van der Veen 1 & Henk G. van der Poel 3 & Elise M. Bekers 4 & Maarten R. Grootendorst 5 & Kunal N. Vyas 5 & Cornelis H. Slump 2 & Marcel P. M. Stokkel 1 Received: 14 November 2019 / Accepted: 19 March 2020 # The Author(s) 2020
Abstract Purpose Currently, approximately 11–38% of prostate cancer (PCa) patients undergoing radical prostatectomy have a positive surgical margin (PSM) on histopathology. Cerenkov luminescence imaging (CLI) using 68Ga-prostate-specific membrane antigen (68Ga-PSMA) is a novel technique for intraoperative margin assessment. The aim of this first-in-man study was to investigate the feasibility of intraoperative 68Ga-PSMA CLI. In this study, feasibility was defined as the ability to distinguish between a positive and negative surgical margin, imaging within 45 min and low radiation exposure to staff. Methods Six patients were included in this ongoing study. Following perioperative i.v. injection of ~ 100 MBq 68Ga-PSMA, the prostate was excised and immediately imaged ex vivo. Different acquisition protocols were tested, and hotspots on CLI images from the intact prostate were marked for comparison with histopathology. Results By using an acquisition protocol with 150 s exposure time, 8 × 8 binning and a 550 nm shortpass filter, PSMs and negative surgical margins (NSMs) were visually correctly identified on CLI in 3 of the 5 patients. Two patients had a hotspot on CLI from cancer < 0.1 mm from the excision margin. Conclusion Overall, the study showed that 68Ga-PSMA CLI is a feasible and low-risk technique for intraoperative margin assessment in PCa. The remaining patients in this ongoing study will be used to assess the diagnostic accuracy of the technique. Trial registration: NL8256 registered at www.trialregister.nl on 04/11/20109. Keywords Cerenkov imaging . 68-Gallium-PSMA intraoperative assessment . Positive surgical margin . Primary prostate cancer
Introduction Approximately 11–38% of patients treated with radical prostatectomy have a positive surgical margin (PSM) on final This article is part of the Topical Collection on Oncology - Genitourinary. * Judith olde Heuvel [email protected] 1
Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
2
Technical Medicine Center, University of Twente, Enschede, Netherlands
3
Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
4
Department of Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
5
Lightpoint Medical Ltd., Chesham, UK
histopathology [1, 2]. Although conflicting results on the long-term oncological effects on survival have been published, adjuvant local radiotherapy was found to reduce biochemical recurrence rate and is therefore offered to men with PSM [1, 3, 4]. Complete surgical excision is challenging as the surgeon currently depends
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