68Ga-PSMA ligand PET/CT integrating indocyanine green-guided salvage lymph node dissection for lymph node metastasis after radical prostatectomy / 亚洲男科学杂志(英文版)

To efficiently remove all recurrent lymph nodes (rLNs) and minimize complications, we developed a combination approach that consisted of 68Gallium prostate-specific membrane antigen (PSMA) ligand positron emission tomography (PET)/computed tomography (CT) and integrated indocyanine green (ICG)-guided salvage lymph node dissection (sLND) for rLNs after radical prostatectomy (RP). Nineteen patients were enrolled to receive such treatment. 68Ga-PSMA ligand PET/CT was used to identify rLNs, and 5 mg of ICG was injected into the space between the rectum and bladder before surgery. Fluorescent laparoscopy was used to perform sLND. While extensive LN dissection was performed at level I, another 5 mg of ICG was injected via the intravenous route to intensify the fluorescent signal, and laparoscopy was introduced to intensively target stained LNs along levels I and II, specifically around suspicious LNs, with 68Ga-PSMA ligand PET/CT. Next, both lateral peritonea were exposed longitudinally to facilitate the removal of fluorescently stained LNs at levels III and IV. In total, pathological analysis confirmed that 42 nodes were rLNs. Among 145 positive LNs stained with ICG, 24 suspicious LNs identified with 68Ga-PSMA ligand PET/CT were included. The sensitivity and specificity of 68Ga-PSMA ligand PET/CT for detecting rLNs were 42.9% and 96.6%, respectively. For ICG, the sensitivity was 92.8% and the specificity was 39.1%. At a median follow-up of 15 (interquartile range [IQR]: 6-31) months, 15 patients experienced complete biochemical remission (BR, prostate-specific antigen [PSA] <0.2 ng ml-1), and 4 patients had a decline in the PSA level, but it remained >0.2 ng ml-1. Therefore, 68Ga-PSMA ligand PET/CT integrating ICG-guided sLND provides efficient sLND with few complications for patients with rLNs after RP.

Research progress of salvage lymph node dissection in advanced prostate cancer / 中华泌尿外科杂志

Prostate cancer (PCa) is one of the most common invasive cancers in men. Radical prostatectomy is the gold standard for localized prostate cancer, but the postoperative biochemical recurrence rate can reach 20%-50%. In some cases, salvage lymph node dissections (SLND) seem to improve cancer control and delay systemic treatment. In this article, we review the current state of diagnostic imaging, accurate patient selection criteria, exploration of SLND surgical procedures, as well as the safety and tumor outcomes of SLND. Overall, although there is still a lack of strong prospective evidence to support the role of SLND, advances in preoperative imaging techniques and the widespread use of minimally invasive surgery have led to encouraging tumor outcomes with SLND. However, further large-scale and high quality trials are needed to confirm the effectiveness and safety of SLND.

Salvage lymph node dissection for metastatic castration resistant prostate adenocarcinoma

@#Presented here is a 66 year old male who is a known case of prostate adenocarcinoma gleason score 9 (4+5) and who underwent open radical retropubic prostatectomy with bilateral pelvic lymph node dissection, followed by 45 cycles of radiation therapy with continous androgen deprivation therapy. Afer completion of radication therapy, Choline PET CT was done which revealed enlarged paracaval, aortocaval and paraaortic lymph nodes. The patient then underwent exploratory laparotomy, retroperitoneal lymph node dissection which found four out of twenty five lymph nodes removed that were positive for tumor metastases. There was a significant drop in the prostate specific antigen level two months post-surgery, from 7.43 to 1.54. Androgen deprivation therapy was still continued post-operatively.