Image-guided detection of lymph node metastases in prostate cancer

Lymph node metastases in prostate cancer patients are linked to worse outcomes, and the optimal treatment for these patients is still debated. Recent advances in imaging, particularly PSMA PET/CT and USPIO MRI, allow earlier and more sensitive detection of lymph node metastases, enabling the identification of limited (oligo-) metastatic disease. This opens the possibility of treating localized metastases with targeted therapies, potentially delaying systemic treatment and disease progression.

This thesis investigated innovative imaging techniques for lymph node metastases before, during, and after surgery. Preoperative PSMA PET/CT was shown to be a strong predictor of biochemical recurrence, while USPIO MRI may detect smaller suspicious nodes. Intraoperative radioguided surgery using PSMA ligands proved feasible and safe, facilitating precise removal of metastatic nodes. Experimental studies also explored PSMA-targeted photodynamic therapy, demonstrating tumor growth delay and increased cell death. Postoperative ex vivo imaging further enhanced detection of metastases beyond standard histopathology.

Overall, these technological advances are poised to influence clinical guidelines and improve diagnosis and treatment strategies for newly diagnosed prostate cancer patients in the coming decade.