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Theranostics 2024; 14(7):2736-2756. doi:10.7150/thno.95039 This issue Cite

Review

Prostate-specific membrane antigen-targeted surgery in prostate cancer: Accurate identification, real-time diagnosis, and precise resection

Jianhua Jiao^1,2#, Jingjing Zhang^3,4,5,8#, Weihong Wen⁶, Weijun Qin^1,2✉, Xiaoyuan Chen^3,4,5,7,8✉

1. Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
2. Innovation Center for Tumor Immunocytology Therapy Technology, Xijing Innovation Research Institute, Fourth Military Medical University, Xi'an, Shaanxi, China.
3. Departments of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119074, Singapore.
4. Clinical Imaging Research Centre, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117599, Singapore.
5. Nanomedicine Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore.
6. Institute of Medical Research, Northwestern Polytechnical University, Xi'an, Shaanxi, China.
7. Institute of Molecular and Cell Biology, Agency for Science, Technology, and Research (A*STAR), 61 Biopolis Drive, Proteos, 138673, Singapore, Singapore.
8. Theranostics Center of Excellenece, Yong Loo Lin School of Medicine, National University of Singapore, 11 Biopolis Way, Helios, Singapore 138667, Singapore.
# These authors contributed equally to this work.

✉ Corresponding authors: Xiaoyuan Chen, PhD, E-mail: chen.shawnedu.sg. Nasrat Muzayyin Professor in Medicine and Technology Yong Loo Lin School of Medicine and Faculty of Engineering National University of Singapore. Weijun Qin, MD, E-mail: qinwjedu.cn. Department of Urology, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, China, 710032; Tel. +86-29-8477-1579, Fax. +86-29-8477-5321 (W. Qin). More

Abstract

Radical prostatectomy (RP) combined with pelvic lymph node dissection (PLND) is the first step in multimodal treatment of prostate cancer (PCa) without distant metastases. For a long time, the surgical resection range has been highly dependent on the surgeon's visualization and experience with preoperative imaging. With the rapid development of prostate-specific membrane antigen positron emission tomography and single-photon emission computed tomography (PSMA-PET and PSMA-SPECT), PSMA-targeted surgery has been introduced for a more accurate pathological diagnosis and complete resection of positive surgical margins (PSMs) and micro-lymph node metastases (LNMs). We reviewed PSMA-targeted surgeries, including PSMA-PET-guided prostatic biopsy (PSMA-TB), PSMA-targeted radio-guided surgery (PSMA-RGS), PSMA-targeted fluorescence-guided surgery (PSMA-FGS), and multi-modality/multi-targeted PSMA-targeted surgery. We also discuss the strengths and challenges of PSMA-targeted surgery, and propose that PSMA-targeted surgery could be a great addition to existing surgery protocols, thereby improving the accuracy and convenience of surgery for primary and recurrent PCa in the near future.

Keywords: prostate cancer, prostate-specific membrane antigen (PSMA), molecular imaging, intraoperative, image-guided surgery

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