Radioguided Surgery for Prostate Cancer

Prostate-specific membrane antigen radioguided surgery (PSMA-RGS) is an emerging technique that provides real-time intraoperative guidance for identification of lymph node metastases (LNMs) in patients with prostate cancer (PC). PSMA-RGS uses PSMA ligands labeled with radionuclides that emit γ or β particles and has shown promise in enhancing the accuracy of surgery. Introduced for salvage lymph node dissection in patients experiencing biochemical recurrence, PSMA-RGS has demonstrated high specificity and positive predictive value, although sensitivity remains limited for micrometastatic disease. Recent studies on PSMA-RGS during extended pelvic lymph node dissection in the primary setting showed that it is safe and feasible, with superior accuracy in comparison to preoperative PSMA positron emission tomography. Despite its advantages, PSMA-RGS has limited sensitivity for micrometastatic LNMs because of spatial resolution for the probe. PSMA-RGS represents a promising tool for optimizing surgical management in PC. However, future studies with long-term follow-up are needed to refine detection strategies and evaluate its oncological impact. Patient summary: Radioguided surgery using radioactive compounds that bind to a protein called PSMA (prostate-specific membrane antigen) is a safe procedure that may help surgeons in identifying metastasis in lymph nodes during robot-assisted surgery for prostate cancer. While this technique has potential to enhance treatment outcomes, further studies are necessary to confirm its long-term benefits.