Imaging Case 19:

Prostate cancer - Adenocarcinoma

Radical prostatectomy often requires sacrificing the neurovascular bundle, which can significantly impact a patient's quality of life, particularly in terms of sexual function and loss of continence. A nerve-sparing approach aims to preserve these structures and reduce the risk of postoperative impotence and incontinence, but it comes with an increased risk of incomplete tumor removal. Therefore, having real-time insights on whether the tumor has been fully resected is highly valuable during nerve-sparing surgery. Recent publications have shown that high-resolution specimen PET-CT imaging may provide such insights [1,3,4,5].

In this case, we illustrate how intraoperative specimen PET-CT imaging with 18F-PSMA allows visualizing the tumor in the resected tissue specimen. This real-time assessment could assist the surgeon in determining whether additional tissue removal is necessary, ultimately improving surgical precision and patient outcomes.

This case is presented with the support of dr. B. Lambert, Prof. dr. K. Decaestecker, dr. F. Ameye, dr. P. De Backer,  and colleagues  of AZ Maria Middelares hospital, Ghent, Belgium, and is part of the investigator driven study to explore potential indications of an intraoperative specimen PET-CT imager (Trial registration number: BUN: B0172022000009).