Summary
- Preoperative imaging techniques, such as mpMRI and microultrasound, are used to improve staging accuracy and detect extraprostatic extension in patients undergoing prostatectomy.
- PSMA-PET-CT has shown promise in detecting extracapsular extension, with PSMA-PET-MRI offering higher accuracy than mpMRI alone.
- Nomograms are used to predict extracapsular extension based on various variables, although their accuracy can vary in external validation studies.
- Intraoperative strategies, including frozen section and technologies like fluorescence confocal microscopy and PET-CT specimen imaging, provide immediate feedback on the completeness of resection during prostatectomy.
- In vivo technologies like augmented reality based on mpMRI and PSMA-guided near-infrared fluorescence are being developed to assist in real-time assessment of prostate cancer location and residual tumor detection during surgery.
A non-systematic review was conducted to explore technologies used in modern prostatectomy procedures for margin assessment and surgical planning. Technologies focused on preoperative, intraoperative in vivo, and intraoperative ex vivo approaches. Preoperative imaging techniques such as mpMRI, microultrasound, and PSMA-PET-CT were discussed for staging accuracy and extraprostatic extension detection. Nomograms were also mentioned to predict extracapsular extension. Intraoperative strategies included ex vivo techniques like frozen section analysis, which is considered the gold standard for assessing surgical margins. In vivo approaches involved technologies like augmented reality based on mpMRI, confocal laser endomicroscopy, and PSMA-guided near-infrared fluorescence for real-time assessment during surgery.
Ex vivo technologies require extraction of the specimen before analysis, providing guidance for additional resection but not immediate visualization of residual tumor location. Frozen section analysis is commonly used for margin assessment and has shown promising results in reducing positive surgical margins. In vivo approaches like augmented reality and confocal laser endomicroscopy provide real-time information during surgery for margin assessment. PSMA-guided near-infrared fluorescence has also shown potential in detecting residual tumors and guiding re-resection. These technologies aim to improve surgical outcomes by providing accurate and immediate feedback on margin status during prostatectomy procedures.
Overall, a variety of modern technologies are being used or developed to improve margin assessment and surgical planning in prostatectomy procedures. From preoperative imaging techniques to intraoperative strategies, these technologies offer enhanced accuracy and real-time information to guide surgical decision-making. While some technologies like frozen section analysis are well-established, newer approaches like PSMA-guided near-infrared fluorescence show promise in detecting residual tumors and improving oncological outcomes. Further research is needed to determine the reproducibility and impact of these technologies on surgical outcomes and patient care. Healthcare professionals can benefit from incorporating these technologies into their practice for more precise and effective prostate cancer management.
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Urology, Oncology, General Surgery