T. Maurer, G. Weirich, , T. Weineisen, B. Frisch, A. Okur, N. Navab, M. Schwaiger, HP Wester, J. Gschwend, M. Eiber PSMA-radioguided surgery for metastatic lymph nodes in prostate cancer European Urology, in press, available online 6 May 2015 (bib)
	With the advent of 68Ga-PSMA-HBED-CC PET hybrid imaging in prostate cancer (PCa) even small metastatic lymph nodes (LN) may be visualized. Intraoperatively, however, these LN might not easily be detected due to their inconspicuous morphology and/or atypical localization. Thus, the aim of this pilot study was to evaluate the feasibility of PSMA-radioguided surgery and to correlate its findings with postoperative histological results. One patient with primary PCa and evidence of LN metastases as well as four PCa patients with evidence of recurrent disease to regional LN on 68Ga-PSMA-HBED-CC PET hybrid imaging received an intravenous injection of 111In-PSMA-I&T 24 hours before surgery. Intraoperatively, metastatic LN were tracked by a gamma probe using acoustic and visual feedback. Radioactive-positive LN specimens detected in vivo were confirmed by ex vivo measurements and corresponded to histopathological metastatic PCa lesions with a specificity of 100%. Detection of small unobtrusive metastatic LN was facilitated by the use of PSMA-radioguided surgery. The intraoperative use of the gamma probe detected all PSMA-positive lesions identified on preoperative 68Ga-PSMA-HBED-CC PET and might even be more accurate due to reduced lesion-to-detector distance. However, greater patient numbers including robust follow-up data are needed to determine the future role of PSMA-radioguided surgery.
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