Real-Time Assessment of Surgical Margins During Radical Prostatectomy: A Comprehensive Review

Radical prostatectomy (RP) is a widely used treatment for localized prostate cancer, where achieving negative surgical margins is essential to reduce the risk of biochemical recurrence (BCR) and avoid additional treatments like radiation therapy. Positive surgical margins (PSMs) are associated with increased recurrence rates, higher costs, and patient anxiety. This review aims to evaluate real-time technologies for surgical margin assessment during RP, focusing on their clinical utility, advancements, and potential to improve intraoperative decision-making.

A non systematic review was conducted by searching PubMed/MEDLINE and Google Scholar for studies on realtime intraoperative margin assessment technologies in RP, including traditional and emerging methods. The review assessed technologies such as frozen section analysis, Confocal Laser Endomicroscopy (CLE), Fluorescence Confocal Microscopy (FCM), Optical Spectroscopy, and Augmented Reality (AR). Data from clinical trials and studies were analyzed based on their sensitivity, specificity, operational feasibility, and potential to reduce PSMs.

Emerging technologies like CLE and FCM have shown significant potential for intraoperative tissue imaging, offering high-resolution, real-time feedback that can help identify cancerous tissue and guide surgical margins. Frozen section analysis remains the gold standard for intraoperative assessment due to its high sensitivity and specificity, but it is time-consuming and dependent on specialized pathology teams. AR, CLE, and optical spectroscopy technologies are gaining attention for their ability to provide real-time data and improve surgical precision. However, challenges such as high costs, technical complexity, and limited availability in resource-limited settings hinder broader adoption. Further clinical validation is needed to confirm their effectiveness and feasibility.

Real-time assessment technologies offer promising advancements in reducing PSMs during RP, potentially improving both oncological and functional outcomes. While frozen section analysis remains the most widely used method, emerging technologies like CLE, FCM, AR, and optical spectroscopy show promise in enhancing surgical precision and patient outcomes. Continued innovation and large-scale clinical trials are crucial for integrating these tools into standard clinical practice and making them more accessible to a broader patient population.