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July 2024 | George M. Pikler, M.D., Ph.D., FACP, Lead Oncology Advocate N1X10

Fluorescent Dye Tracks Prostate Cancer Cells

Prostate cancer (PC) is the second most common male malignancy globally. In the US alone, it is estimated that 299,010 new cases will be diagnosed in 2024, with 35,250 prostate cancer deaths. Robot-assisted laparoscopic radical prostatectomy (RARP) is one of the main treatment options for clinically localized PC. The main challenge remains with the inability of surgeons to identify the extent of prostate cancer intraoperatively in order to decide whether the neurovascular bundles situated in the postero-lateral aspect of the prostate gland can be safely preserved or sacrificed, and a further inability to visualize small-volume disease infiltrating lymph nodes. Despite improved diagnostic imaging with multiparametric MRI, approximately one-third of patients undergoing surgery are upstaged to more advanced disease, frequently requiring adjuvant or salvage therapies.

These shortfalls have driven much innovation using prostate-specific membrane antigen (PSMA) in image-guided surgical technologies. PSMA is cell-surface glycoprotein over-expressed in the majority of prostate cancer cells. Its expression level is related to tumor invasiveness. It represents an ideal target to develop sensitive radio-active and fluorescent tracers. UK researchers from University of Oxford have developed a special type of fluorescent dye that seems to help surgeons to see cancerous tissue they might otherwise miss. The glowing dye attaches to the PSMA and with special lighting shone on to the prostate, the cancer cells show up. In an early trial in 23 men who underwent surgery for prostate cancer, surgeons spotted cancer cells that had spread to nearby tissue and lymph nodes, which they say would not have been picked up by the naked eye and may have been missed with conventional methods.

Surgeon and study co-author Freddie Hamdy explains, “with this technique, we can strip all the cancer away, including the cells that have spread from the tumor which could give it the chance to come back later.” He believes the method will mean more healthy tissue can be preserved in surgery, reducing the chance of side effects that can sometimes happen following prostate operations, such as erectile dysfunction and incontinence.

Eur J Nucl Med Mol Imaging. 2024; June 10
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Erica

Erica Cross, PA

PA

Erica is a board certified Physician Assistant. She obtained her Master’s degree in Physician Assistant studies from Our Lady of the Lake College in Baton Rouge, LA. She began practicing in 2011 and has worked clinically in Orthopedics and Dermatology. The majority of her career has been spent in a Dermatology practice where she assisted in Mohs surgery, treating various types of skin cancer. She also teaches in the medical simulation department at the University of South Alabama and enjoys every aspect of medical education.