Intraoperative Molecular Positron Emission Tomography Imaging for Intraoperative Assessment of Radical Prostatectomy Specimens

Christopher Darr; Pedro Fragoso Costa; Theresa Kahl; Alexandros Moraitis; Jenna Engel; Mulham Al-Nader; Henning Reis; Jens Köllermann; Claudia Kesch; Ulrich Krafft; Tobias Maurer; Daniel Köhler; Susanne Klutmann; Fabian Falkenbach; Jens Kleesiek; Wolfgang P Fendler; Boris A Hadaschik; Ken Herrmann

doi:10.1016/j.euros.2023.05.017

Intraoperative Molecular Positron Emission Tomography Imaging for Intraoperative Assessment of Radical Prostatectomy Specimens

Eur Urol Open Sci. 2023 Jun 15:54:28-32. doi: 10.1016/j.euros.2023.05.017. eCollection 2023 Aug.

Authors

Christopher Darr¹, Pedro Fragoso Costa², Theresa Kahl¹, Alexandros Moraitis², Jenna Engel¹, Mulham Al-Nader¹, Henning Reis³, Jens Köllermann³, Claudia Kesch¹, Ulrich Krafft¹, Tobias Maurer^{4

5}, Daniel Köhler⁶, Susanne Klutmann⁶, Fabian Falkenbach⁴, Jens Kleesiek⁷, Wolfgang P Fendler², Boris A Hadaschik¹, Ken Herrmann²

Affiliations

¹ Department of Urology, University Hospital Essen, Essen, Germany.
² Department of Nuclear Medicine, University Hospital Essen, Essen, Germany.
³ Department of Pathology, University Hospital Frankfurt, Frankfurt, Germany.
⁴ Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
⁵ Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
⁶ Department for Diagnostic and Interventional Radiology and Nuclear Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
⁷ Institute of Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany.

Abstract

In this prospective two-center feasibility study, we evaluate the diagnostic value of intraoperative ex vivo specimenPET/CT imaging of radical prostatectomy (RP) and lymphadenectomy specimens. Ten patients with high-risk prostate cancer underwent clinical prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) preoperatively on the day of surgery. Six patients received ⁶⁸Ga-PSMA-11 and four ¹⁸F-PSMA-1007. Radioactivity of the resected specimen was measured again using a novel specimenPET/CT device (AURA10; XEOS Medical, Gent, Belgium) developed for intraoperative margin assessment. All index lesions of staging multiparametric magnetic resonance imaging could be visualized. Overall, specimenPET/CT correlated well with conventional PET/CT regarding detection of suspicious tracer foci (Pearson coefficient 0.935). In addition, specimenPET/CT demonstrated all lymph node metastases detected on conventional PET/CT (n = 3), as well as three previously undetected lymph node metastases. Importantly, all positive or close (<1 mm) surgical margins could be visualized in agreement with histopathology. In conclusion, specimenPET/CT enables detection of PSMA-avid lesions and warrants further investigation to tailor RP, based on a good correlation with final pathology. Future trials will prospectively compare ex vivo specimenPET/CT with a frozen section analysis for the detection of positive surgical margins and assessment of biochemical recurrence-free survival.

Patient summary: In this report, we examined prostatectomy and lymphadenectomy specimens for suspicious positron emission tomography (PET) signals after preoperative tracer injection. It was found that in all cases, a good signal could be visualized, with a promising correlation of surface assessment compared with histopathology. We conclude that specimenPET imaging is feasible and may help improve oncological outcomes in the future.

Keywords: Prostate cancer; Prostate-specific membrane antigen positron emission tomography/computed tomography; Radical prostatectomy; SpecimenPET/CT.