Lymph Node Staging in Prostate Cancer

Sankineni, Sandeep; Brown, Anna M.; Fascelli, Michele; Law, Yan Mee; Pinto, Peter A.; Choyke, Peter L.; Türkbey, Barış

doi:10.1007/s11934-015-0505-y

Cited by 53 publications

(32 citation statements)

References 64 publications

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“…Patients with stage ≤T2, PSA <10 ng/ml, a Gleason score ≤6, and <50% positive biopsy cores have a <10% likelihood of having LN metastases and can be spared LN evaluation [38]. Currently, surgical pelvic lymph node dissection (PLND) with histopathological examination is the standard of care and the most commonly used method of LN staging [38,39]. However, PLND can be challenging and with risk of complications like lymphocele, infection, deep venous thrombosis, bleeding, and urinary retention that may result in prolonged hospital stays [40].…”

Section: Psma Pet In Primary Stagingmentioning

confidence: 99%

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PSMA PET and Radionuclide Therapy in Prostate Cancer

Bouchelouche

Türkbey

Choyke

2016

Seminars in Nuclear Medicine

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Prostate cancer (Pca) is the most common malignancy in men and a major cause of cancer death. Accurate imaging plays an important role in diagnosis, staging, restaging, detection of biochemical recurrence, and for therapy of PCa patients. Since no effective treatment is available for advanced PCa, there is an urgent need to develop new and more effective therapeutic strategies. In order to optimize treatment outcome, especially in high risk PCa patients, therapy of PCa is moving rapidly towards personalization. Medical imaging, including positron emission tomography (PET)/computed tomography (CT), plays an important role in personalized medicine in oncology. In the recent years, much focus has been on prostate specific membrane antigen (PSMA) as a promising target for imaging and therapy with radionuclides, since it is upregulated in most PCa. In the prostate, one potential role for PSMA PET imaging is to help guiding focal therapy. Several studies have shown great potential of PSMA PET/CT for initial staging, lymph node staging, and detection of recurrence of PCa, even at very low PSA values after primary therapy. Furthermore, studies have shown that PSMA PET/CT has a higher detection rate than choline PET/CT. Radiolabeled PSMA ligands for therapy show promise in several studies with metastatic PCa, and is an area of active investigation. The “Image and treat” strategy, with radiolabeled PSMA ligands, has the potential to improve the treatment outcome of PCa patients, and is paving the way for precision medicine in PCa. The aim of this review is to give an overview of recent advancement in PSMA PET and radionuclide therapy of PCa.

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Section: Psma Pet In Primary Stagingmentioning

confidence: 99%

“…The most commonly used threshold for enlarged LNs is 10 mm in short axis diameter, but recommended thresholds vary from 8 mm to 15 mm [39]. However, almost 80% of metastatic LNs in PCa are smaller than the threshold size of 8 mm and, therefore, cannot be detected using morphological imaging [41].…”

Section: Psma Pet In Primary Stagingmentioning

confidence: 99%

PSMA PET and Radionuclide Therapy in Prostate Cancer

Bouchelouche

Türkbey

Choyke

2016

Seminars in Nuclear Medicine

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“…Compared with traditional surgical dissection, Ferumoxtran‐10 offers a noninvasive approach to identifying malignant lymph nodes. After administration, Ferumoxtran‐10 is slowly extravasated from blood vessels to the interstitial space following phagocytosis by macrophages, and is finally transported to normal lymph nodes . Accumulation of USPIOs within normal lymph nodes induces a significant susceptibility effect, resulting in a dramatic signal loss in T 2 *‐weighted MRI .…”

Section: T2 Mri Contrast Agentsmentioning

confidence: 99%

Functional nanoparticles for magnetic resonance imaging

Mao

Cui

2016

WIREs Nanomed Nanobiotechnol

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Nanoparticle-based magnetic resonance imaging (MRI) contrast agents have received much attention over the past decade. By virtue of a high payload of magnetic moieties, enhanced accumulation at disease sites, and a large surface area for additional modification with targeting ligands, nanoparticle-based contrast agents offer promising new platforms to further enhance the high resolution and sensitivity of MRI for various biomedical applications. T2* superparamagnetic iron oxide nanoparticles (SPIONs) first demonstrated superior improvement on MRI sensitivity. The prevailing SPION attracted growing interest in the development of refined nanoscale versions of MRI contrast agents. Afterwards, T1-based contrast agents were developed, and became the most studied subject in MRI due to the positive contrast they provide that avoids the susceptibility associated with MRI signal reduction. Recently, chemical exchange saturation transfer (CEST) contrast agents have emerged and rapidly gained popularity. The unique aspect of CEST contrast agents is that their contrast can be selectively turned “on” and “off” by radiofrequency (RF) saturation. Their performance can be further enhanced by incorporating a large number of exchangeable protons into well-defined nanostructure. Besides activatable CEST contrast agents, there is growing interest in developing nanoparticle-based activatable MRI contrast agents responsive to stimuli (pH, enzyme, etc.), which improves sensitivity and specificity. In this review, we summarize the recent development of various types of nanoparticle-based MRI contrast agents, and have focused our discussions on the key advantages of introducing nanoparticles in MRI.

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“…Currently the most promising target for molecular probes is the prostate-specific membrane antigen (PSMA) transmembrane glycoprotein. However, radiolabeled-PSMA ligands remain at an experimental stage in diagnostic imaging of the prostate, and there has been little experience in their integration into SLND [48][49][50].…”

Section: Future Trendsmentioning

confidence: 99%

“…Compared to other tissue cells that express the same protein, PSMA is significantly overexpressed on 90-100% of local and metastatic PCa cells with propensity for highgrade, metastatic disease [48,[50][51][52]. Afshar-Oromieh et al demonstrated that for recurrent PCa, the extracellular PMSA inhibitor 68 Ga-PSMA PET/CT was more sensitive than conventional 18 F-choline PET/CT in detecting more and smaller nodes even at low PSA levels [52].…”

Section: Future Trendsmentioning

confidence: 99%

Current perspectives of sentinel lymph node dissection at the time of radical surgery for prostate cancer

Munbauhal

Seisen

Gomez

et al. 2016

Cancer Treatment Reviews

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The sentinel lymph node dissection (SLND) concept relies on the accurate detection of primary nodal landing sites and could represent a major advancement towards accurate, non-invasive pelvic staging in prostate cancer (PCa). Different iterations of the technique have now been validated and reproduced mostly in large-volume centres. The existing evidence denotes the feasibility and sensitivity of SLND, with encouraging pre- and intraoperative detection rates of 98% and 96%. Yet, current surgical practice mandates a backup template dissection due to a false negative rate, up to 7.1%, of tracer-guided surgery. In practice, SLND failed to achieve nodal detection in up to 20% of pelvic sidewalls. Despite scarce validated evidence, current consensus mainly attributes these false negative cases to altered prostatic drainage secondary to malignant obliteration of lymphovascular structures. In parallel, multiple SLND studies have highlighted the complex and variable drainage pathways from the prostate, furthering the established anatomical atlases. The most promising approach may therefore rely in magnetic nanoparticles and PCa-targeting ligands. However, in the absence of a clear sentinel node or region for the prostate, formal SLND is difficult to integrate in routine surgical practice for now. As such, tracer-guided dissection is only used as a complementary intervention to highlight first- echelon nodes and aberrant lymphatic pathways found beyond the commonly adopted pelvic lymphadenectomy templates.

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Lymph Node Staging in Prostate Cancer

Cited by 53 publications

References 64 publications

PSMA PET and Radionuclide Therapy in Prostate Cancer

PSMA PET and Radionuclide Therapy in Prostate Cancer

Functional nanoparticles for magnetic resonance imaging

Current perspectives of sentinel lymph node dissection at the time of radical surgery for prostate cancer

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