Robot-Assisted Single-Port PSMA-Radioguided Surgery for Isolated Seminal Vesicle Recurrence of Prostate Cancer After Multimodal Therapy

Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) detects recurrent prostate cancer at low prostate-specific antigen (PSA) levels, and PSMA-radioguided surgery (PSMA-RGS) localizes PSMA-avid tissue intraoperatively with a gamma probe. We report, to our knowledge, the first published case of PSMA-RGS with a robotic single-port (SP) platform. A man with high-risk prostate cancer diagnosed at age 63 had received irreversible electroporation, stereotactic body radiotherapy, intermittent bicalutamide, and PSMA radioligand therapy, but no radical prostatectomy. More than ten years later, PSA rose to 0.32 ng/mL during bicalutamide therapy, and [18F]PSMA-1007 PET/computed tomography showed a solitary 13 × 11 mm lesion in the right seminal vesicle. After preoperative injection of [99mTc]Tc-PSMA-I&S, the lesion was localized with a drop-in gamma probe and resected using the da Vinci SP system. Ex vivo measurement confirmed removal of the tracer-avid target; no residual activity was detected in the resection bed. Operative time was 80 min and estimated blood loss 10 mL, without intraoperative complications; the patient was discharged on day 3. Histopathology confirmed adenocarcinoma infiltrating the seminal vesicle, with negative margins. Four weeks after surgery and discontinuation of bicalutamide, PSA was 0.02 ng/mL. SP PSMA-RGS was feasible; its oncological value requires longer follow-up.