Revolutionizing Prostate Cancer Surgery: How the DETECT Trial's Radioguided Technique Could Change the Game
Study Overview
The study, titled "Prostate-Specific Membrane Antigen–Targeted Radioguided Pelvic Lymph Node Dissection in Newly Diagnosed Prostate Cancer Patients with a Suspicion of Locoregional Lymph Node Metastases: The DETECT Trial" was designed as a prospective phase I/II trial. It focused on patients with newly diagnosed prostate cancer, particularly those with at least one lymph node showing suspicion of metastasis on preoperative 18F-PSMA PET/CT (1). The intervention under investigation was PSMA-targeted radioguided surgery (RGS), performed after administering 111In-PSMA-I&T. This technique was aimed at optimizing the peroperative detection and removal of PSMA-avid lymph node metastases.
The study did not have a traditional control group since it was primarily concerned with the feasibility and safety of the intervention. A total of 20 patients were included, and the study assessed the safety of the procedure by monitoring adverse events and the feasibility by evaluating the peroperative detection of suggestive lymph nodes as identified in preoperative imaging.
Key results included that no tracer-related adverse events were reported, 43 of 49 (88%) 18F-PSMA PET–suggestive lesions were successfully removed, and 111In-PSMA RGS facilitated the peroperative identification and resection of 29 of 49 (59%) target lesions. Of these, 28 (97%) contained lymph node metastases. The study concluded that 111In-PSMA RGS is a safe and feasible procedure that assists in the peroperative detection of 18F-PSMA PET/CT–suggestive lesions in newly diagnosed prostate cancer patients.
Standard Treatment
The standard treatment for newly diagnosed prostate cancer, particularly in patients with suspected locoregional lymph node metastases, typically involves a combination of therapies. The primary treatments include surgery (radical prostatectomy) and radiation therapy, often accompanied by androgen deprivation therapy (ADT). The choice between these options depends on various factors including the stage and grade of the cancer, patient health, and potential side effects. Advanced cases may require more aggressive treatment approaches like chemotherapy. It's important to consult current medical guidelines and healthcare professionals for the most up-to-date and personalized treatment information.
Clinical Impact Potnetial
The clinical impact potential of the "DETECT Trial" on prostate cancer treatment can be assessed as medium. This assessment is based on the study's innovation in applying PSMA-targeted radioguided surgery (RGS), which demonstrated feasibility and safety in detecting and removing lymph node metastases. The medium impact is attributed to the potential improvement in surgical accuracy and outcomes for patients with prostate cancer. However, further studies and broader clinical trials are necessary to fully establish its efficacy and integration into standard treatment protocols, which tempers the immediate impact of this study.