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Focal Laser Ablation of Prostate Cancer: An Office Procedure
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The LaserSAFE technique for margin assessment during radical prostatectomy: a feasibility study.
Ricardo Almeida-Magana1,2, Larissa Sena Teixeira Mendes1,3, Eoin Dinneen1,2,4
1Division of Medicine and Interventional Science, Department of Targeted Intervention, Faculty of Medical Sciences, University College London, London, UK.
BJU International
|November 27, 2025
Summary
LaserSAFE, a novel confocal microscopy technique, offers rapid and accurate intraoperative margin assessment for prostate cancer surgery. While a multicentre trial comparing it to NeuroSAFE was not feasible, LaserSAFE shows promise for broader real-time margin evaluation.
Area of Science:
- Urology
- Surgical Oncology
- Medical Imaging
Background:
- Robot-assisted radical prostatectomy for localized prostate cancer requires precise surgical margin assessment.
- Current methods like NeuroSAFE have limitations in speed and feasibility for multicentre trials.
- Novel techniques are needed to improve real-time intraoperative margin evaluation.
Purpose of the Study:
- To evaluate the feasibility of a multicentre trial comparing NeuroSAFE with LaserSAFE.
- To assess the diagnostic performance of LaserSAFE for real-time surgical margin assessment.
- To compare the speed and accuracy of LaserSAFE versus NeuroSAFE.
Main Methods:
- A prospective, non-randomised feasibility study at a single UK academic centre.
- Inclusion of patients with localized prostate cancer (T2-T3a N0 M0) unsuitable for nerve sparing.
- LaserSAFE imaging performed intraoperatively, with decisions guided by NeuroSAFE; retrospective pathologist evaluation of LaserSAFE images.
Main Results:
- 20 patients recruited in 12 months; multicentre expansion was not feasible.
- LaserSAFE demonstrated high sensitivity (0.91) and specificity (1.00) for detecting positive margins (≥0.5 mm).
- LaserSAFE was significantly faster (median 7 min) than NeuroSAFE (median 63 min), with strong agreement between modalities.
Conclusions:
- A multicentre study comparing NeuroSAFE was not achievable.
- LaserSAFE is a rapid and accurate alternative for intraoperative margin assessment.
- Further trials are warranted to incorporate LaserSAFE for real-time margin assessment and nerve-sparing decisions.
