Precision low-dose brachytherapy of prostate cancer under PSMA-receptor molecular visualization

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Abstract

Brachytherapy with implantation of micro sources based on isotope 125I is a preferred treatment for localized prostate cancer without signs of germination of the gland capsule and in the absence of signs of metastases (stage cT1-T23aN0M0). Structural imaging methods (ultrasound, computed tomography, and magnetic resonance imaging) do not have high specificity in the differential diagnosis of prostate cancer. Hybrid technologies of radiation imaging (single-photon emission computed tomography/computed tomography, positron emission tomography/computed tomography, and positron emission tomography/magnetic resonance imaging) combine the advantages of high sensitivity of cross-sectional structural imaging methods (computed tomography and magnetic resonance imaging) and high specificity of molecular imaging methods (single-photon emission computed tomography and positron emission tomography) with tumorotropic radiopharmaceuticals. In this original clinical study, based on seven observations of localized prostate cancer (Gleason 6–7), it was shown that the precision of low-dose brachytherapy using 125I micro sources of localized prostate carcinomas, along with targeted biopsy, can be increased using hybrid methods of PSMA-receptor molecular imaging (single-photon emission computed tomography/ computed tomography, positron emission tomography/ computed tomography). The single-photon emission computed tomography/ computed tomography method is more accessible than positron emission tomography/ computed tomography. Moreover, when coupled with cold kits (HYNIC-PSMA), it allows research within any radioisotope diagnostics laboratory equipped with single-photon emission computed tomography/ computed tomography. The innovative technology of PSMA-navigation biopsy and brachytherapy, under the control of hybrid molecular imaging, can be used in primary and recurrent cases of localized prostate cancer, increases the accuracy and reduces the traumatic nature of procedures, and increases the medical and economic efficiency of low-dose brachytherapy with 125I micro sources. Further research is needed to improve the technology and evaluate its long-term results.

About the authors

Pavel V. Sviridov

Medical center “Doctor Plus”

Email: p_sviridov73@mail.ru
ORCID iD: 0009-0008-3362-8255
SPIN-code: 4702-3067
Russian Federation, Obninsk

Pavel O. Rumiantsev

Clinics group “My Medical Center”

Author for correspondence.
Email: pavelrum@gmail.com
ORCID iD: 0000-0002-7721-634X
SPIN-code: 7085-7976
Scopus Author ID: 110759

MD, Dr. Sci. (Med.)

Russian Federation, Saint Peterburg

Mikhail V. Degtyarev

Endocrinology Research Centre

Email: germed@mail.ru
ORCID iD: 0000-0001-5652-2607
SPIN-code: 7725-7831
Russian Federation, Moscow

Sergey S. Serzhenko

Endocrinology Research Centre

Email: vv1ld@yandex.ru
ORCID iD: 0000-0003-2326-1396
SPIN-code: 4713-8986
Russian Federation, Moscow

Dmitry B. Sanin

Medical center “Doctor Plus”; National Medical Research Radiological Center

Email: dimitresko82@yandex.ru
ORCID iD: 0009-0004-2047-4921
SPIN-code: 8939-9101

Cand. Sci. (Biol.)

Russian Federation, Obninsk; Obninsk

Sergey V. Styrov

Medical center “Doctor Plus”

Email: rizost@yandex.ru
ORCID iD: 0000-0003-4315-8855
SPIN-code: 9019-8520
Scopus Author ID: 924845
Russian Federation, Obninsk

Dmitry Yu. Agibalov

Medical center “Doctor Plus”

Email: agibalovd@bk.ru
ORCID iD: 0000-0003-2995-7140
SPIN-code: 6938-5804
Russian Federation, Obninsk

Sergey V. Korenev

I. Kant Baltic Federal University

Email: korenevsv@mail.ru
ORCID iD: 0000-0003-2310-0576
SPIN-code: 5257-4476

MD, Dr. Sci. (Med.), Professor

Russian Federation, Kaliningrad

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Supplementary files

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2. Fig. 1. Stages of dosimetry planning of brachytherapy localized prostate cancer using 125I microsources considering SPECT/CT with 99mTc-HYNIC-PSMA: (a) topometric marking and (b) topometric marking and dosimetry planning of brachytherapy.

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3. Fig. 2. Patient Zh., 8 years old, SPECT/CT with 99mTc-HYNIC-PSMA, axial projection: Site of radiopharmaceutical accumulation in the transition zone of the middle part of the right prostate lobe.

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4. Fig. 3. Patient Z., 7 years old, SPECT/CT with 99mTc-HYNIC-PSMA: Sites of radiopharmaceutical accumulation in transitory zones of both lobes at the border of the middle third and the apex of the prostate gland.

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5. Fig. 4. Patient K., 73 years old, SPECT /CT with 99mTc-HYNIC-PSMA, (a) frontal and (b) axial sections: Sites of radiopharmaceutical accumulation in the anterior part of the transition zone in the apex of the right lobe, posterolateral part of the peripheral zone at the level of the base of the left lobe, and posterolateral part of the peripheral zones at the level of the base and middle third of the left lobe of the prostate gland; physiological accumulation of radiopharmaceuticals in the bladder.

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6. Fig. 5. Patient F., 68 years old, SPECT/CT with 99mTc-HYNIC-PSMA: Sites of radiopharmaceutical accumulation at the border of the central zone and the posterolateral part of the peripheral zone on the right side at the level of the base of the right prostate lobe. The scan visualizes multiple rods in the prostate gland, implanted during previous brachytherapy.

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7. Fig. 6. Patient G., 70 years old, SPECT/CT with 99mTc-HYNIC-PSMA: Site of radiopharmaceutical accumulation in the posterolateral part of the peripheral zone of the middle part of the right prostate lobe. Multiple rods in the prostate gland were implanted during previous brachytherapy.

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8. Fig. 7. Patient M., 65 years old, SPECT/CT with 99mTc-HYNIC-PSMA: Site of radiopharmaceutical accumulation in the transition zone (at the border of the middle third and the base) of the left prostate lobe.

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9. Fig. 8. Patient M., 69 years old, PET/CT with 68Ga-PSMA-11: Sites of radiopharmaceutical accumulation in the prostate gland, multifocal tumor.

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10. Fig. 9. Changes in prostate-specific antigen levels in individual patients.

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11. Fig. 10. Algorithm for selecting patients for low-dose brachytherapy, emphasizing increasing precision under PSMA-receptor molecular imaging guide. ku, contrast enhancement; LDR, low-dose rate; PSMA, prostate-specific membrane antigen.

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