MOLECULAR IMAGING AND INTRAOPERATIVE RADIONAVIGATION IN PROSTATE CANCER

Introduction. Prostate cancer is one of the most common malignant neoplasms. Strategies to improve early diagnosis and subsequent therapy are being improved. An emphasis is placed on maintaining the quality of life and working capacity of patients after treatment. This can be achieved by improving methods of focal therapy, which depends on the accuracy of topical diagnosis and classification of the tumor. Hybrid molecular imaging (pet/ct and spect/ct) is used in addition to the methods of structural imaging (ultrasound, ct, mri). Intraoperative imaging using radionavigation systems is also used in open and endoscopic surgery for prostate cancer. Currently, it is a tool capable of reducing the invasiveness of surgery, localizing the area of metastatic lesions with a sensitivity and specificity of up to 95 %.

Objective of the study: an overview of current and promising future methods of intraoperative radio navigation in the surgical treatment of prostate cancer.

Material and methods. The review presents the methods of intraoperative radionavigation in the surgical treatment of prostate cancer. Radionavigation in the context of using tumarotropic radiopharmaceutical based on a prostate-specific membrane antigen, in which the drug accumulates in all tumor foci expressing this receptor, is also considered.

Conclusion. The use of preoperative hybrid imaging and radio-guided surgery facilitate lesion identification and resection. Gamma probing allows detection of psma-positive tumor foci regardless of their depth. Fluorescence imaging methods (icg, photodynamic diagnostics, autofluorescence) are also used for intraoperative detection of pathological foci in real time. Multichannel gamma probing and cherenkov radiation detection, which combine the advantages of indirect and direct intraoperative imaging, have enormous potential.

1. Rawla P. Epidemiology of Prostate Cancer. World J Oncol. 2019 Apr; 10(2): 63–89. doi: 10.14740/wjon1191.

2. World Health Organization. Global cancer observatory: cancer today [Internet]. URL: https://gco.iarc.fr/today (cited 16.11.2020).

3. Pernar C.H., Ebot E.M., Wilson K.M., Mucci L.A. The Epidemiology of Prostate Cancer. Cold Spring Harb Perspect Med. 2018 Dec 3; 8(12): a030361. doi: 10.1101/cshperspect.a030361.

4. Alekseev B.Ya., Kaprin A.D., Kolontarev K.B., Matveev V. B., Pushkar D. Yu., Rasner P. I., Kharchilava R.R. Clinical recommendations. Prostate cancer. 2018. 7. (in Russian).

5. Pieters B. Randomized trial for the evaluation of erectile dysfunction after whole or partial gland prostate brachytherapy. 2018. 25 p.

6. Chen F.Z., Zhao X.K. Prostate cancer: current treatment and prevention strategies. Iran Red Crescent Med J. 2013; 15(4): 279–84. doi: 10.5812/ircmj.6499.

7. Vidal-Sicart S., Valdés Olmos R., Nieweg O.E, Faccini R., Grootendorst M.R., Wester H.J., Navab N., Vojnovic B., van der Poel H., Martínez-Román S., Klode J., Wawroschek F., van Leeuwen F.W.B. From interventionist imaging to intraoperative guidance: New perspectives by combining advanced tools and navigation with radio-guided surgery. Rev Esp Med Nucl Imagen Mol (Engl Ed). 2018 Jan-Feb; 37(1): 28–40. doi: 10.1016/j.remn.2017.06.004.

8. Maurer T., Graefen M., van der Poel H., Hamdy F., Briganti A., Eiber M., Wester H.J., van Leeuwen F.W.B. Prostate-Specific Membrane Antigen-Guided Surgery. J Nucl Med. 2020; 61(1): 6–12. doi: 10.2967/jnumed.119.232330.

9. Povoski S.P., Neff R.L., Mojzisik C.M., O'Malley D.M., Hinkle G.H., Hall N.C., Murrey D.A.Jr., Knopp M.V., Martin E.W.Jr. A comprehensive overview of radioguided surgery using gamma detection probe technology. World J Surg Oncol. 2009 Jan 27; 7: 11. doi: 10.1186/1477-7819-7-11.

10. Parris C.C., Bigelow R.R., Francis J.E., Kelly G.G., Bell P.R. A Csi(Ti)-crystal surgical scintillation probe. Nucleonics. 1956; 14: 102–108.

11. Descotes J.L. Diagnosis of prostate cancer. Asian J Urol. 2019 Apr; 6(2): 129–136. doi: 10.1016/j.ajur.2018.11.007.

12. Wawroschek F., Vogt H., Weckermann D., Wagner T., Harzmann R. The sentinel lymph node concept in prostate cancer – first results of gamma probe-guided sentinel lymph node identification. Eur Urol. 1999 Dec; 36(6): 595–600. doi: 10.1159/000020054.

13. Silver D.A., Pellicer I., Fair W.R., Heston W.D., Cordon-Cardo C. Prostate-specific membrane antigen expression in normal and malignant human tissues. Clin Cancer Res. 1997 Jan; 3(1): 81–5.

14. Hovels A.M., Heesakkers R.A., Adang E.M., Jager G.J., Strum S., Hoogeveen Y.L., Severens J.L. , Barentsz J.O. The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol. 2008; 63: 387–395.

15. De Visschere P.J.L., Standaert C., Fütterer J.J., Villeirs G.M., Panebianco V., Walz J., Maurer T., Hadaschik B.A., Lecouvet F.E., Giannarini G., Fanti S. A Systematic Review on the Role of Imaging in Early Recurrent Prostate Cancer. Eur Urol Oncol. 2019 Feb; 2(1): 47–76. doi: 10.1016/j.euo.2018.09.010.

16. van Leeuwen F.W.B., Winter A., van Der Poel H.G., Eiber M., Suardi N., Graefen M., Wawroschek F., Maurer T. Technologies for imageguided surgery for managing lymphatic metastases in prostate cancer. Nat Rev Urol. 2019 Mar; 16(3): 159–171. doi: 10.1038/s41585-018-0140-8.

17. Litwin M.S., Tan H.J. The Diagnosis and Treatment of Prostate Cancer: A Review. JAMA. 2017; 317(24): 2532–2542. doi: 10.1001/jama.2017.7248.

18. Wallitt K.L., Khan S.R., Dubash S., Tam H.H., Khan S., Barwick T.D. Clinical PET Imaging in Prostate Cancer. Radiographics. 2017 Sep-Oct; 37(5): 1512–1536. doi: 10.1148/rg.2017170035.

19. Rauscher I., Krönke M., König M., Gafita A., Maurer T., Horn T., Schiller K., Weber W., Eiber M. Matched-Pair Comparison of 68Ga-PSMA-11 PET/CT and 18F-PSMA-1007 PET/CT: Frequency of Pitfalls and Detection Efficacy in Biochemical Recurrence After Radical Prostatectomy. J Nucl Med. 2020 Jan; 61(1): 51–57. doi: 10.2967/jnumed.119.229187.

20. Maurer T., Robu S., Schottelius M., Schwamborn K., Rauscher I., van den Berg N.S., van Leeuwen F.W.B., Haller B., Horn T., Heck M.M., Gschwend J.E., Schwaiger M., Wester H.J., Eiber M. 99mTechnetiumbased Prostate-specific Membrane Antigen-radioguided Surgery in Recurrent Prostate Cancer. Eur Urol. 2019 Apr; 75(4): 659–666. doi: 10.1016/j.eururo.2018.03.013.

21. Watson A.A. The discovery of Cherenkov radiation and its use in the detection of extensive air showers. Nuclear Physics. 2011; 212–213: 13–19. doi: 10.1016/j.nuclphysbps.2011.03.003.

22. Olde Heuvel J., de Wit-van der Veen B.J., Vyas K.N., Tuch D.S., Grootendorst M.R., Stokkel M.P.M., Slump C.H. Performance evaluation of Cerenkov luminescence imaging: a comparison of 68Ga with 18F. EJNMMI Phys. 2019 Oct 24; 6(1): 17. doi: 10.1186/s40658-019-0255-x.

23. Olde Heuvel J., de Wit-van der Veen B.J., van der Poel H.G., Bekers E.M., Grootendorst M.R., Vyas K.N., Slump C.H., Stokkel M.P.M. 68Ga-PSMA Cerenkov luminescence imaging in primary prostate cancer: first-in-man series. Eur J Nucl Med Mol Imaging. 2020 Oct; 47(11): 2624–2632. doi: 10.1007/s00259-020-04783-1.

24. Todd R., Nightingale J., Everett D. A proposed Gamma camera. Nature. 1974; 251: 132–134. doi: 10.1038/251132a0.

25. Schonefelder V., Diehl R., Lichti G.G., Steinle H., Swanenburg B.N., Deerenberg A.J.M., Aarts H., Lockwood J., Webber W. The imaging Compton telescope COMPTEL on the gamma ray observatory. IEEE Trans. Nucl. Sci. 1984; 66–70. doi: 10.1109/TNS.1984.4333363.