State of the Art in Prostate-specific Membrane Antigen-targeted Surgery-A Systematic Review

Context: Identifying malignant tissue and leaving adjacent structures undisturbed constitute an ongoing challenge in prostate cancer (PCa) surgery. Image and radio-guided surgical technologies targeting the prostate-specific membrane antigen (PSMA) receptor may facilitate identification and removal of diseased tissue. Objective: To perform a systematic review of the clinical studies on PSMA-targeted surgery. Evidence acquisition: The MEDLINE (OvidSP), Embase.com, and Cochrane Library databases were searched. Identified reports were critically appraised according to the Idea, Development, Exploration, Assessment, Long-term framework criteria. The risk of bias (RoB) was assessed as per the Risk Of Bias In Non-randomized Studies-of Interventions tool. The strengths and limitations of the techniques and corresponding oncological outcomes were extracted as areas of interest. Data were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Evidence synthesis: In total, 29 reports were selected, including eight prospective studies, 12 retrospective analyses, and nine case reports, all with a high or an unclear RoB. In 72.4% of studies, PSMA targeting was achieved via radioguided sur-gery (RGS), predominantly using 99mTc-PSMA-I & S (66.7%). Hybrid approaches that complement RGS with optical guidance are emerging. The majority of studies retrieved were pilot studies with a short follow-up. In 13 reports, salvage lymph node surgery was discussed (44.8%). In 12 more recent reports (41.4%), PSMA tar-geting was studied in primary PCa surgery (50.0% lymph nodes and 50.0% surgical

Automated summary

PSMA-targeted surgery helps identify and remove malignant tissue in prostate cancer patients while preserving adjacent structures. Most studies on PSMA-targeted surgery are pilot studies with short follow-up periods.