A Phase 2 interventional study of 99m-TC-PSMA-I&S in Prostate Cancer, sponsored by IRCCS San Raffaele. Completed at 1 site in Italy. Open to male participants aged 18 Years to 80 Years. Per ClinicalTrials.gov, last updated 2025-03-14.
Sponsored by IRCCS San Raffaele · Phase 2, Interventional, and Diagnostic
The project aims at assessing the role of radio-guided surgery in the detection of lymph node invasion (LNI) in prostate cancer (PCa) patients undergoing radical prostatectomy (RP) by using an intraoperative gamma probe and a radioactive labelled PSMA ligand (99mTc-PSMA-I\&S). We hypothesize that 99mTc-PSMA-I\&S radio-guided surgery (99mTc-PSMA-RGS) might assist physicians in the identification of patients with LNI candidate for an extended pelvic lymph node dissection (ePLND). Overall, 100 men with a LNI risk >5% according to the Briganti nomogram will be submitted to 68Ga-PSMA PET/MRI followed by 99mTc-PSMA-RGS and ePLND. The aims are 1) to assess the safety and tolerability of 99mTc-PSMA-I\&S; 2) to assess the accuracy of 99mTc-PSMA-RGS in the identification of LNI compared to available clinical tools and to molecular imaging (i.e., 68Ga-PSMA PET/MRI); 3) to assess whether 99mTc-PSMA-RGS would allow for the identification of positive nodes outside the standard ePLND template.
Potential participants will be identified, screened and recruited by the Urologists working at the Department of Urology, IRCCS San Raffaele, Milan, Italy. A total of 100 patients affected by PCa with a risk of LNI >5% according to the Briganti nomogram and planned to receive RARP with an ePLND according to the European Association of Urology (EAU) guidelines will be identified and enrolled in the study.
The patient must personally sign and date the latest approved version of the Informed Consent Form (ICF) before any trial specific procedures are performed.
Written and verbal versions of the Patient Information and Informed Consent will be presented to the participants detailing no less than:
The participant will be allowed as much time as wished to consider the information and the opportunity to question the Investigator, their GP or other independent parties to decide whether they will participate in the trial. Written Informed Consent will then be obtained by means of participant dated signature and dated signature of the person who presented and obtained the Informed Consent. The person who obtained the consent must be suitably qualified and experienced, and have been authorized to do so by the Principal Investigator.
A copy of the signed Informed Consent will be given to the participant. The original signed form will be retained at the trial Centre.
A Patient ID number will be assigned to each patient after the ICF signature: this number corresponds to the Progressive Number assigned in chronological order beginning from 001 (i.e. 001, 002, etc.). For instance, the first patient enrolled will receive the following ID Number: 001.
During Visit 1, the following data will be collected:
Laboratory testing (absolute neutrophil count; platelets; haemoglobin; serum creatinine) The week before surgery patients will undergo a 68Ga-PSMA PET/MRI or PET/CT scan for preoperative staging. Simultaneous PET/MRI will start 60 minutes after the administration of approximately 160MBq of PSMA with the following protocol: localizer MRI scans to define the number of table positions (PET-FOV) to acquire (4-min/table position); specific attenuation correction and anatomical localization MR sequences at each PET-FOV; pelvic mpMRI protocol according to European Society of Urogenital Radiology guidelines. A positive 68Ga-PSMA PET/MRI will be defined as the presence of any uptake at the level of the pelvic and/or retroperitoneal nodes. The results of this procedure will not change the initially planned treatment.
99mTc-PSMA-I\&S will be intravenously injected the day before surgery (day -1). 99mTc-PSMA-I\&S will be prepared using a synthesis kit previously described [25]. SPECT/CT imaging will be performed the same day of treatment administration (day -1) to document positive tracer uptake and will serve as quality control for tracer injection and distribution.
All procedures will be performed through a trans-peritoneal approach using the Da Vinci Xi (Intuitive Surgical, Sunnyvale, CA, USA) robotic Surgical System. The patient will be placed in a Trendelenburg position. After incision of the peritoneum, release of the bladder laterally to the endopelvic fascia, the ureter will be localized.
A drop-in gamma probe will be used for in vivo intraoperative measurements to identify metastatic lesions at the level of the internal iliac, external iliac, obturatory and common iliac stations. A positive finding at PSMA-RGS will be defined as the presence of a count rate of at least twice as compared to the background reference (namely, fatty tissue of each patient). All positive lesions (a count rate of at least twice as compared to the background reference) will be excised. Ex vivo gamma measurements will be performed to immediately to confirm the removal of the radioactive lesion or to prompt further search in case of a missing signal. All the removed tissue will be collected separately according to the site of resection.
6,370 studies on the registry are indexed under Prostatic Neoplasms; 1,400 are open to participants now.
This study's enrollment of 81 is above the median of 58 across 4,822 interventional studies indexed under Prostatic Neoplasms.
Browse Prostatic Neoplasms studies →IRCCS San Raffaele is the lead sponsor of 443 studies on the registry; 234 are open to participants now.
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Exclusion Criteria:
* 68Ga-PSMA PET/MRI acquisition * 99mTc-PSMA-I\&S intravenous injection the day before surgery * 99mTc-PSMA-I\&S SPECT/CT imaging * 99mTc-PSMA-RGS to detect an increased count rate at the level of the nodal stations * Robot-assisted ePLND followed by RP * 99mTc-PSMA-RGS to detect an increased count rate in the prostatic fossa after removal of the primary tumor * Histopathological examination * Monitoring of adverse events and perioperative outcomes after surgery
Drug: 99m-TC-PSMA-I&S
* 99mTc-PSMA-I\&S intravenous injection the day before surgery * 99mTc-PSMA-I\&S SPECT/CT imaging * 99mTc-PSMA-RGS to detect an increased count rate at the level of the nodal stations
Rate of lymph node invasion
Rate of LNI observed at final pathology after 99mTc-PSMA-RGS (histopathological evaluation of the lymph nodes)
Time frame: 12 weeks
Side effects
Side effects associated with the administration of 99mTC-PSMA-I\&S (day 0)
Time frame: day 0
Postoperative complications
Rate of intraoperative complications associated with 99mTc-PSMA-RGS assessed at visit 2
Time frame: day 28 and day 84
Nodal invasion outside the template
Rate of LNI observed at final pathology in nodes outside the extended nodal dissection template detected only by 99mTc-PSMA-RGS
Time frame: 12 weeks
Plan to share: No
This study is completed, as verified in Dec 2024. You cannot join it, but the record below documents what was studied.
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IRCCS San Raffaele