Radioguided Salvage Pelvic Node Dissection in Oligometastatic Prostate Cancer - SALVAGE

The goal of this clinical trial is to learn whether radioguided surgery can help surgeonsfind and remove lymph nodes containing prostate cancer in men whose cancer has returnedin a small number of lymph nodes after previous prostate cancer treatment. It will alsolearn about the safety of this approach, changes in prostate‐specific antigen (PSA),quality of life, and longer‐term cancer outcomes.The main questions the study aims to answer are:Does radioguided surgery increase the proportion of removed lymph nodes that are found tocontain prostate cancer compared with standard surgery? How well do the lymph nodesidentified on imaging scans match the cancer found when the removed lymph nodes areexamined in the laboratory? Does radioguided surgery lead to a greater decrease in PSAafter surgery? What side effects or surgical complications occur? How does each type ofsurgery affect quality of life, the need for additional cancer treatment, and the risk ofthe cancer spreading? Researchers will compare radioguided salvage lymph node surgerywith standard salvage lymph node surgery. Salvage lymph node surgery is an operation toremove lymph nodes after prostate cancer has returned.Participants will:Be randomly assigned to one of two treatment groups. Have surgery to remove lymph nodessuspected of containing prostate cancer. If assigned to the radioguided group, receive aradioactive PSMA‐targeting tracer called 99mTc‐MIP‐1404, undergo a SPECT/CT scan, andhave surgery the following day. During surgery, the surgeon will use a handheld detectorto locate lymph nodes that have taken up the tracer.If assigned to the standard‐surgery group, have surgery planned using a standardPSMA‐PET/CT scan, without the handheld radioguidance procedure.Have PSA blood tests, assessments for complications, and quality‐of‐life questionnairesafter surgery.Be followed for cancer outcomes for up to two years.