PSMA-PET guided hook-wire localization of nodal metastases in prostate cancer: a targeted approach

Prostate Specific Membrane Antigen Positron Emission Tomography/Computed Tomography (PSMA-PET/CT) has increased the sensitivity and specificity of imaging to identify metastatic prostate cancer in the group of patients with early biochemical recurrence when compared to conventional imaging. In patients who develop biochemical recurrence of prostate cancer following surgical resection, salvage lymph node dissection may reduce prostate specific antigen (PSA) levels and delay the time for commencement of systemic therapies. However, PLND may be an anatomically and technically difficult procedure, particularly with small metastatic diseases which can be problematic for intra-operative identification. We describe the technique using PSMA-PET imaging to pre-operatively localise areas of low-volume nodal metastatic disease with hookwire to allow targeted lymph node dissection with direct visualisation and palpation to ensure adequate clearance of involved nodes.