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Radioguided Surgery Accurately Detects and Removes Metastatic Lymph Nodes in Prostate Cancer Patients

By MedImaging International staff writers
Posted on 06 Mar 2024

Image: Preoperative and postoperative PSMA-PET/CT images showing removal of positive pelvic lymph nodes in radioguided surgical procedure (Photo courtesy of M.G.M. Schilham)

In patients newly diagnosed with prostate cancer, the presence and location of lymph node metastases are critical for guiding clinical decisions and planning treatment. This is because nodal involvement is associated with the recurrence of the disease. Identifying these metastases can significantly benefit patients, enabling them to receive adjuvant therapies like radiation and chemotherapy, which can enhance their outcomes. Currently, extended pelvic lymph node dissection (ePLND) is regarded as the most effective method for nodal staging. This surgical procedure aims to remove as many metastatic lymph nodes as possible from the pelvic region. While the therapeutic impact of ePLND in prostate cancer remains a subject of debate, there's evidence suggesting that removing all nodal metastases could lead to optimal control of the disease in the local and regional areas.

Now, a new study by researchers at the Radboud University Medical Centre (Nijmegen, Netherlands) has revealed that radioguided surgery is capable of detecting and extracting metastatic pelvic lymph nodes in patients newly diagnosed with prostate cancer. This technique focuses on the prostate-specific membrane antigen (PSMA), commonly overexpressed in prostate cancer cases, enhancing nodal staging and thereby aiding in forming treatment strategies for this crucial patient group. The study incorporated 20 newly diagnosed patients with prostate cancer, each with at least one lymph node suspected of metastasis based on a preoperative 18F-PSMA PET/CT scan. They underwent 111In-PSMA-radioguided surgery to remove the metastatic nodes, followed by a postoperative 18F-PSMA PET/CT scan confirming the successful excision of these lesions. This study was crucial in evaluating the safety and practicality of 111In-PSMA-radioguided surgery and its precision in identifying metastatic lymph nodes.

The study reported no adverse events linked to the 111In-PSMA-radioguided surgery. In the procedure, 29 out of 49 lesions were identified and excised, with 28 of them (97%) confirmed to be lymph node metastases. Additionally, 14 out of the 49 (29%) removed lymph nodes, which were not identified by the radioguided surgery, included two that had metastases. Although previous research has examined the feasibility of PSMA-radioguided pelvic lymph node surgery, this study is among the first to explore this method in a larger cohort of newly diagnosed patients. The results underscore the safety and feasibility of this innovative surgical technique. Importantly, each patient underwent postoperative imaging, a vital step in confirming the reliability of the outcomes.

“The current results demonstrate the great potential for radioguided surgery in prostate cancer and highlight the expanding role of molecular imaging at the operating room,” said Mark Rijpkema, PhD, principal investigator at the Radboud University Medical Centre. “Optimization of tracers and larger clinical trials may further improve surgical outcomes in the future by implementing both measurements of removed tissue, as well as real-time measurements during surgery.”

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Radboud University Medical Centre

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88 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

90 (293.01643371582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800480 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800480 AND published='1' LIMIT 1

91 (94.890594482422): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800480 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800480 AND published='1' LIMIT 1

92 (!!!!! 2178.9073944092): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294800480 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

93 (289.2017364502): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800480 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800480 AND published='1' LIMIT 1

94 (54.836273193359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800480 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800480 AND published='1' LIMIT 1

95 (443.93539428711): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294800480 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

96 (!!!!! 7764.1010284424): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

97 (!!!!! 7997.989654541): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

98 (182.15179443359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800480 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800480 AND published='1' LIMIT 1

99 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800480 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800480 AND published='1' LIMIT 1

100 (!!!!! 3272.0565795898): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800480 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800480 AND published='1' LIMIT 1

101 (!!!!! 2152.9197692871): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800480 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800480 AND published='1' LIMIT 1

102 (416.04042053223): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800480 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800480 AND published='1' LIMIT 1

103 (!!!!! 6760.1203918457): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800480 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800480 AND published='1' LIMIT 1

104 (!!!!! 4214.0483856201): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

105 (!!!!! 105463.0279541): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

106 (!!!!! 13561.964035034): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800480 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800480 AND published='1' LIMIT 1

107 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800480 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800480 AND published='1' LIMIT 1

108 (481.12869262695): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294800480 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294800480 AND type='deeppockets_item' AND published='1' LIMIT 1

109 (!!!!! 886388.06343079): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

110 (53.882598876953): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

111 (34.093856811523): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

112 (27.894973754883): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

113 (33.140182495117): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

114 (28.133392333984): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

115 (28.133392333984): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

116 (27.179718017578): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

117 (442.9817199707): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800480 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

118 (267.98248291016): SELECT name FROM jos_deeppockets WHERE id=213

119 (92.983245849609): SELECT name FROM jos_deeppockets WHERE id=213

120 (570.05882263184): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

121 (403.88107299805): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

122 (130.89179992676): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800480 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800480 AND published='1' LIMIT 1

123 (90.122222900391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800480 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800480 AND published='1' LIMIT 1

124 (!!!!! 10011.911392212): TRUNCATE TABLE jos_trademed_module

125 (!!!!! 2097.1298217773): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294800480 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

126 (!!!!! 7672.0714569092): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800480 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

127 (!!!!! 4043.8175201416): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800480 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

128 (114.91775512695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800480 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800480 AND published='1' LIMIT 1

129 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800480 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800480 AND published='1' LIMIT 1

130 (!!!!! 1251.9359588623): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

131 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800480 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800480 AND published='1' LIMIT 1

132 (59.127807617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800480 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800480 AND published='1' LIMIT 1

133 (98.943710327148): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294800480 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294800480 AND type='deeppockets_item' AND published='1' LIMIT 1

134 (46.014785766602): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=213 or channel_id is null)

135 (41.961669921875): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=213 or channel_id is null)

136 (46.968460083008): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

137 (119.92454528809): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800480 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800480 AND published='1' LIMIT 1

138 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800480 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800480 AND published='1' LIMIT 1

139 (51.021575927734): select jos_twitters.link from jos_twitters where cat=10

140 (30.994415283203): select jos_facebook.link from jos_facebook where cat=10

141 (34.093856811523): select jos_google_plus.link from jos_google_plus where cat=10

142 (35.04753112793): select jos_linkedin.link from jos_linkedin where cat=10

143 (243.9022064209): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

144 (!!!!! 1238.8229370117): insert into jos_banners_delta values (14615,'2025-04-29 10:59:57','3.131.158.219','view'),(14202,'2025-04-29 10:59:57','3.131.158.219','view'),(14203,'2025-04-29 10:59:57','3.131.158.219','view')

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