ABSTRACT
The review examines the vital role of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in the diagnosis, staging, and treatment of prostate cancer (PCa). It focuses on the superior diagnostic abilities of PSMA PET/CT for identifying both nodal and distant PCa, and its potential as a prognostic indicator for biochemical recurrence and overall survival. Additionally, we focused on the variability of PSMA's expression and its impact on personalised treatment, particularly the use of [177Lu] Lu-PSMA-617 radioligand therapy. This review emphasises the essential role of PSMA PET/CT in enhancing treatment approaches, improving patient outcomes, and reducing unnecessary interventions, positioning it as a key element in personalised PCa management.
ABSTRACT
BACKGROUND: [18F]PSMA-1007 is a promising tracer for integrated positron emission tomography and computed tomography (PET/CT). OBJECTIVE: Our aim was to assess the diagnostic accuracy of [18F]PSMA-1007 PET/CT for primary staging of lymph node metastasis before robotic-assisted laparoscopy (RALP) with extended lymph node dissection (ePLND). DESIGN, SETTING AND PARTICIPANTS: The study was a retrospective cohort in a tertiary referral center. Men with prostate cancer that underwent surgical treatment for intermediate- or high-risk prostate cancer between May 2019 and August 2021 were included. INTERVENTIONS: [18F]PSMA-1007 PET/CT for initial staging followed by RALP and ePLND. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES: Sensitivity and specificity were calculated both for the entire cohort and for patients with lymph node metastasis ≥ 3 mm. Positive (PPV) and negative (NPV) predictive values were calculated. RESULTS AND LIMITATIONS: Among 104 patients included in the analyses, 26 patients had lymph node metastasis based on pathology reporting and metastases were ≥ 3 mm in size in 13 of the cases (50%). In the entire cohort, the sensitivity and specificity of [18F]PSMA-1007 were 26.9% (95% confidence interval (CI); 11.6-47.8) and 96.2% (95% CI; 89.2-99.2), respectively. The sensitivity and specificity of [18F]PSMA-1007 to detect a lymph node metastasis ≥ 3 mm on PET/CT were 53.8% (95% CI; 25.1-80.8) and 96.7% (95% CI; 90.7-99.3), respectively. PPV was 70% and NPV 93.6%. CONCLUSIONS: In primary staging of intermediate- and high-risk prostate cancer, [18F]PSMA-1007 PET/CT is highly specific for prediction of lymph node metastases, but the sensitivity for detection of metastases smaller than 3 mm is limited. Based on our results, [18F]PSMA-1007 PET/CT cannot completely replace ePLND. This study investigated the use of an imaging method based on a prostate antigen-specific radiopharmaceutical tracer to detect lymph node prostate cancer metastasis. We found that it is unreliable to discover small metastasis.
ABSTRACT
OBJECTIVE: The standard surgical treatment for benign prostatic hypertrophy (BPH) is transurethral resection of the prostate (TURP). The aim of this study was to compare normal saline (NS) (0.9% sodium chloride) and Ringer's acetate (RA) as irrigation fluid with regard to visibility, resection feasibility, coagulation and bleeding in bipolar TURP. MATERIALS AND METHODS: Twenty patients (mean age 70 years) who were diagnosed with BPH were recruited to the study. The first three 3 liter bags of irrigation fluid contained either NS or RA and were administered in a randomized fashion. The surgeon assessed visibility, bleeding, coagulation, resection efficacy and overall outcome after each 3 liter bag on a scale of 1-10. RESULTS: The results disclosed only marginal differences between the two fluids with regard to the recorded parameters. All of the differences lacked statistical significance (p > .05). CONCLUSION: RA can be used as an irrigation fluid in bipolar TURP with no obvious difference in comparison with NS.
