LaserSAFE: A Fast, Accurate Technique For Evaluating Margins during Prostate Cancer Surgery

What is it about?

This study investigates the feasibility of a multicentre trial comparing the NeuroSAFE technique with a novel method called LaserSAFE, which utilizes confocal laser microscopy for real-time surgical margin assessment in patients undergoing robot-assisted radical prostatectomy for localized prostate cancer. Conducted as a non-randomised, prospective feasibility study at a high-volume UK academic center, the study included 20 patients with clinical T2-T3a N0 M0 prostate cancer who were unsuitable for bilateral intrafascial nerve sparing. LaserSAFE was evaluated for its diagnostic performance, achieving a sensitivity of 0.91 and specificity of 1.00 for detecting positive surgical margins, and demonstrated strong agreement with NeuroSAFE and final pathology. Although expanding the study to additional centers proved unfeasible, LaserSAFE was notably quicker, with a median completion time of 7 minutes compared to 63 minutes for NeuroSAFE. The findings suggest LaserSAFE as a rapid and accurate alternative for intraoperative margin assessment, supporting the potential design of a larger trial to inform nerve-sparing decisions. Limitations of the study include the small sample size, single-centre setting, and the lack of intraoperative decision-making based on LaserSAFE results.

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Photo by JJ Ying on Unsplash

Photo by JJ Ying on Unsplash

Why is it important?

This research explores the feasibility of using a novel technique, LaserSAFE, for real-time surgical margin assessment in robot-assisted radical prostatectomy for patients with localized prostate cancer. The study is significant as it addresses the need for effective intraoperative techniques to minimize functional side effects, a priority in prostate cancer treatment due to the long-term survival of patients. Understanding the performance and feasibility of LaserSAFE can lead to improved surgical outcomes and inform larger studies. Key Takeaways: 1. The study investigates the feasibility of conducting a multicentre trial comparing the NeuroSAFE technique with LaserSAFE, highlighting challenges in expanding the trial to multiple centres due to implementation limitations. 2. Findings reveal that LaserSAFE demonstrated high diagnostic accuracy with a sensitivity of 0.91 and specificity of 1.00 for detecting positive surgical margins, offering a rapid alternative to the NeuroSAFE technique. 3. Although conducted at a single site, the study supports the potential for LaserSAFE to inform nerve-sparing decisions in future trials, emphasizing the need for larger studies to validate its use in real-time surgical margin assessment.