PSMA-Radioguided Surgery (PSMA-RGS) for Metastatic Lymph Nodes in Prostate Cancer at Urological Clinic of TUM Hospital Rechts der Isar

PSMA-Radioguided Surgery (PSMA-RGS) at the Urological Clinic of TUM Klinikum Rechts der Isar in Munich is an image-guided surgical approach designed to help surgeons precisely localize and remove PSMA-expressing prostate cancer lesions, most often small lymph-node metastases that are difficult to detect by sight or palpation alone. The method combines preoperative PSMA imaging and radiotracer administration with intraoperative detection using a handheld gamma probe and is performed in close collaboration between the Department of Urology and the Department of Nuclear Medicine within the same university hospital. At Rechts der Isar, PSMA-RGS is presented as a surgical procedure guided by a PSMA-targeting radiotracer signal. The radiotracer is used for localization; the cancer tissue is removed surgically. This distinction matters because PSMA radioligand therapy is a systemic treatment concept, while PSMA-RGS is a metastasis-directed operative technique used in selected clinical scenarios. University Hospital Rechts der Isar is an early pioneer site for PSMA radio-guided surgery, reporting that the technique was introduced there in 2014 and developed further within the hospital’s interdisciplinary structure. The University Prostate Cancer Center, ProstaTUM, is an interdisciplinary collaboration of multiple departments at the hospital, providing coordinated diagnostics, therapy, and follow-up for prostate cancer patients. Patient selection for PSMA-RGS is typically imaging-driven. A prerequisite is a positive PSMA-PET scan that localizes a limited, targetable recurrence, commonly soft-tissue or lymph-node disease, because the operation is intended to remove discrete PSMA-avid lesions rather than treat diffuse systemic spread. In practice, the preoperative work-up usually includes review of prior treatments and pathology, PSA kinetics, and staging with PSMA-PET/CT or PET/MRI where available, together with standard pre-anesthesia blood testing and perioperative assessment. The operative concept is straightforward but technically powerful. A PSMA-targeting radiotracer is administered intravenously preoperatively so that PSMA-expressing tumor deposits accumulate a signal that can later be detected in the operating room. Under general anesthesia, the surgeon uses a gamma probe to scan suspected regions, identify lesions with higher signal, and guide resection while minimizing unnecessary removal of uninvolved tissue. In a TUM analysis of salvage PSMA-RGS, intraoperative specimen assessment (“radioactive rating”) showed high diagnostic performance against histopathology, with reported specimen-based sensitivity of 83. 6%, specificity of 100%, and accuracy of 93. 0%, supporting the claim that the technique can reliably differentiate many metastatic from non-metastatic specimens during surgery.