Fluorescence in prostate cancer surgery

Prostate cancer is different from many other solid tumours, mainly because of its multifocal growth pattern, which precludes a conservative approach during surgery. 1 Mottet N van den Bergh RCN Briers E et al. EAU-EANM-ESTROESUR-SIOG guidelines on prostate cancer—2020 update. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2021; 79: 243-262 Summary Full Text Full Text PDF PubMed Scopus (931) Google Scholar Moreover, even when spread to the locoregional lymph nodes, it cannot always be clearly identified during surgery. This has led to two different surgical management scenarios. For organ-confined disease, the inability to identify the boundaries of the tumour within the gland makes the radical excision of the gland necessary, which has a substantial effect on patients' postoperative functional outcomes and leading to a not negligible rate of positive surgical margins. 2 Lane JA Donovan JL Davis M et al. Active monitoring, radical prostatectomy, or radiotherapy for localised prostate cancer: study design and diagnostic and baseline results of the ProtecT randomised phase 3 trial. Lancet Oncol. 2014; 15: 1109-1118 Summary Full Text Full Text PDF PubMed Scopus (179) Google Scholar For locally advanced disease involving locoregional lymph nodes, the inability to intraoperatively identify metastatic lymph nodes has limited the role of extended pelvic lymph node dissection to a staging procedure. 3 Lestingi JFP Guglielmetti GB Trinh QD et al. Extended versus limited pelvic lymph node dissection during radical prostatectomy for intermediate- and high-risk prostate cancer: early oncological outcomes from a randomized phase 3 trial. Eur Urol. 2021; 79: 595-604 Summary Full Text Full Text PDF PubMed Scopus (61) Google Scholar First-in-patient study of OTL78 for intraoperative fluorescence imaging of prostate-specific membrane antigen-positive prostate cancer: a single-arm, phase 2a, feasibility trialThis first-in-patient study showed that OTL78 was well tolerated and had the potential to improve prostate cancer detection. Optimal dosing was 0·03 mg/kg, 24 h preoperatively. PSMA-directed fluorescence imaging allowed real-time identification of visually occult prostate cancer and might help to achieve complete oncological resections. Full-Text PDF