Better detection and removal of prostate cancer metastases thanks to new surgical technique

Last week, for the first time in the Netherlands, the Netherlands Cancer Institute – part of the Netherlands Prostate Cancer Network – performed a new technique to detect and remove highly specific lymph node metastases of prostate cancer in a robot-assisted operation. During the operation a flexible detector scans the patient’s body and, following administration of a radioactive agent, detects lymph node metastases that used to be difficult to find or were too complicated to remove surgically. This enables prostate cancer metastases to be detected and removed with even greater precision and more effectively, thus improving oncological outcomes and quality of life for prostate cancer patients.

Patients are increasingly being diagnosed with small numbers of lymph node metastases using a PSMA PET/CT scan, a scan which is already in common clinical use to visualise prostate cancer. In some patients it can be worthwhile to remove these lymph nodes surgically, but they are not always located during an operation, as they are at places in the body that are difficult to access.

New advanced technique provides greater precision
For the first time in the Netherlands it has been possible to detect prostate cancer metastases during an operation using a radioactive signal. A unique detector (developed by the Interventional Molecular Imaging Laboratory of Leiden University Medical Center (LUMC) in collaboration with the Netherlands Cancer Institute) is used for this purpose. Having been selected for radio-guided surgery (based on PSMA PET/CT), the patient is administered a radioactive agent (^99mTechnetium labelled PSMA ligand) a day before the start of the operation. This binds to the prostate cancer cells, turning the metastases in the lymph nodes radioactive. The lymph node detector, known as a DROP-IN gamma probe, is attached at the end of a flexible cable and can search for radioactive signals in all directions in the body during the operation. The new technology now makes it possible to detect small prostate cancer metastases (upwards of 2mm) during surgery. “I operate the detector using an arm of the surgical robot. As soon as the detector finds the nodes, the device emits a signal”, explains Pim van Leeuwen, a urologist at the Netherlands Cancer Institute. “That enables me to detect the lymph node metastases with great precision and remove them. This is a major step forward in prostate cancer surgery technology.”

Prostate cancer is the most common type of cancer in men in the Netherlands. Every year 13,600 men are diagnosed with it, and some of them suffer from lymph node metastases.

Study:
Following almost two years of detailed preparation, this is the first time in the Netherlands that this innovative technique has been used, in a cancer operation at the Netherlands Cancer Institute. The TRACE study has been developed through collaboration between the Netherlands Cancer Institute’s Urology and Nuclear Medicine departments and pharmacy and the LUMC’s Interventional Molecular Imaging Laboratory. As part of the clinical trial the results of the radioactive tissue removed are compared with the findings of the pathologist who assesses the tissue after the operation. The oncological results of the operation are examined a few weeks later.

Please contact your physician if you think that you might quality for trial participation.

Prostate cancer is one of the most common cancer types in the Netherands. 13,600 men are diagnosed with this cancer type every year. Some of them will experience lymph node metastases.