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PSMA Radioguided Surgery
- Days In Hospital 1 days
- Outside Hospital Stay 7 days
- Success Rate %
Minimum Cost
$ 4000
Maximum Cost.
$ 7200
Overview of PSMA Radioguided Surgery in India
Identifying the exact site of recurrence can be one of the most challenging aspects of managing prostate cancer once surgery or radiation has been performed. PSMA radioguided surgery is a technology that can assist surgeons in locating and removing tumours from patients with significant accuracy beyond the limits of visual assessments and physical examinations.
PSMA radioguided surgery is a specialised process employed primarily for relapsed or localised prostate cancer cases. The idea behind it is to combine the results obtained through the use of nuclear imaging techniques with real-time surgical intervention.
The treatment involves the use of the mentioned techniques, the application of drugs, targeted injections with radioligands, and the guiding of instruments during surgery.
What is PSMA Radioguided Surgery?
PSMA means Prostate-Specific Membrane Antigen—a protein that shows up in large amounts on most prostate cancer cells. In PSMA radioguided surgery (PSMA-RGS), doctors inject a radioactive tracer that sticks to this protein right before the operation.
As the surgery happens, the surgeon uses a handheld gamma probe to spot the cancerous tissue. This tool picks up signals from spots where the tracer has collected, letting the team see exactly where the cancer is—right then and there, not just on older scans or by eyesight alone.
Compared to regular prostate cancer surgery that depends on scans done days or weeks earlier, PSMA-RGS gives instant feedback. That way, surgeons can better tell what to remove and don’t have to guess, which means there’s a better shot at getting all the tumour out.
Types of PSMA Radioguided Surgery:
The operational measuring approach (in vivo vs. ex vivo), the clinical context (primary vs. salvage/recurrent), and the surgical technique (open vs. robot-assisted) are the three main categories of PSMA-RGS.
Measurement and Detection Types
In Vivo Radioguided Surgery: The gamma probe is used by a surgeon, which is sterile and handheld, to detect gamma emissions of the cancer spots from within the patient.
Ex Vivo Radioguided Surgery: The surgeon uses a gamma probe on the removed tissue samples from outside the patient's body, which eliminates any interference from the body’s background radiation and provides an accurate confirmation standard.
Clinical Setting Types
Primary Staging / Lymph Node Dissection: Employed in the early radical prostatectomy surgeries to identify any hidden or below one-centimetre lymph nodes and assist in performing an extended pelvic lymph node dissection.
Salvage Lymph Node Dissection (in Case of Recurrence): Utilised when there is a recurrence of prostate cancer in order to identify and remove tiny non-typical metastasis that standard imaging cannot detect successfully.
Index Lesion and Local Staging: This is a new technique that is currently being employed in order to identify the limits of the primary tumour, see if it has spread beyond the prostate (extraprostatic extension), or check the surgical margin during the prostatectomy.
Surgical Approach Types
Open Radioguided Surgery: The conventional open procedure that requires making big cuts to enable the usage of larger handheld gamma probes for scanning o the operating bed.
Robot-Assisted Radioguided Surgery: Involves the use of small “drop-in” gamma probes (for instance, the SENSEI system) operated by robots or bedside assistants and providing real-time data through sound or display to the doctor onboard.
Procedure:
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Cost of PSMA Radioguided Surgery in India
In India, targeting of PSMA therapy (‘Lu-117 PSMA radioligand therapy’ instead of a usual radioguided procedure) has an average price of $4000-$7200 per course. The overall cost of a comprehensive course with many cycles is approximately $6000 to $17000 depending on the hospital, isotope used, and the number of injections applied in each cycle.
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Indications of PSMA Radioguided Surgery:
PSMA radioguided surgery is usually suitable for patients experiencing the following:
Rising PSA after initial treatment: After the operation or radiation treatment, the elevated level of prostate-specific antigen (PSA) may point to the possible comeback of the cancer despite the negative results of conventional imaging methods.
PSMA PET scan-positive recurrence: The intervention may also be done using the following imaging method for detecting localised recurrence areas.
Oligometastatic disease: PSMA radioguided surgery is more likely to be suitable for patients with a few, small, localised tumours, as this surgery is aimed at removing particular accumulations only instead of treating the disease throughout the body.
Lymph node-confined recurrence: When the cancer has spread to the lymph nodes only and has not reached bones or other organs of the body, it is one of the most common indicators.
Inconclusive conventional imaging: When conventional imaging methods cannot provide clarity regarding the presence of recurrence that is detected through blood testing methods, PSMA imaging and surgery can effectively help identify the location of recurrence.
Risk Factors:
PSMA radioguided surgery isn’t something you try to avoid in the first place—it’s a treatment you might need after dealing with prostate cancer. Certain things make it more likely someone will need this surgery down the line:
Higher initial Gleason score: If the original cancer had a high Gleason score, meaning it was aggressive from the start, it’s more likely to come back.
Positive surgical margins: When surgeons find cancer cells right up to the edge of the tissue they remove, there’s a bigger risk the cancer will return locally.
Lymph node involvement at diagnosis: Patients who already had cancer in their lymph nodes when first diagnosed are more prone to see it come back in those same areas later.
Rapid PSA doubling time: If a person’s PSA levels jump up quickly after treatment, there’s often a good chance of finding a new, treatable spot of cancer.