To this day, the gold standard for node staging still is extended dissection of pelvic nodes. ( 10) reported the overall disagreement in PET-positive findings between 68Ga-PSMA PET-CT and PET-MRI was very low, and the consistence between the methods was very high. Recent studies show encouraging results from 68Ga-PSMA PET-CT in patients with biochemical relapse, with greater accuracy for lymph node evaluation when compared to conventional exams ( 11, 12) and the use of 68Ga-PSMA PET-CT has already become a recommendation in guidelines for investigation of patients with biochemical recurrence. ( 10) The radiopharmaceutical labeled with gallium 68, 68Ga-PSMA-11-HBED-CC, or simply 68Ga-PSMA, is a synthetic antigen inhibitor that, when injected into the patient, binds to the cells of the primary prostate cancer and its metastases. In the case of prostate cancer, the expression of this protein tends to be associated with tumor differentiation. Prostate membrane-specific antigen (PMSA) is a cell membrane-binding protein that is overexpressed in malignant prostate cancers, especially adenocarcinoma and its metastases, and is found at low levels in healthy organs. New technologies have been studied aiming to increase diagnostic accuracy, with special focus on nuclear medicine and new radiopharmaceuticals. ( 8) Positron emission computed tomography (PET-CT) and magnetic resonance imaging (PET-MRI) techniques have been widely used to detect the presence of lymph nodes metastases, but none of these methods proved to be accurate for preoperative N staging. ![]() Positron emission tomography (PET) is a tomographic technique that measures, in three dimensions, the distribution of positron-emitting radiopharmaceuticals (a drug that has a radioactive element in its composition), which allows non-invasive quantitative and qualitative assessment of physiological and biochemical processes. ![]() ( 5) It is estimated that approximately 40% of high-risk lesions initially staged as no node metastasis (N0) actually have lymph node metastases. ( 4) Accurate nodal staging (N staging) is therefore key for planning treatment and postoperative follow-up. ( 2, 3) In men treated with radical prostatectomy for localized prostate cancer, the presence of lymph node metastases is a strong adverse prognostic factor associated with higher recurrence rates and shorter long-term survival. Using conventional imaging tests, it is still a challenge to detect the exact site of recurrence and optimally guide personalized treatment. Pelvic lymph nodes are a common site of recurrent disease and may change the clinical management. Of these cases, approximately 12,000 were diagnosed in the state of São Paulo. It is estimated that approximately 61,200 cases are diagnosed annually in Brazil, accounting to roughly 23% of all cancers diagnosed in men in the country. Prostate cancer is the most prevalent solid tumor among men.
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