Emerging imaging-guided technologies, such as prostate-specific membrane antigen radioguided surgery (PSMA-RGS) and augmented reality (AR), could enhance the precision and efficacy of robot-assisted prostate cancer (PCa) surgical approaches, maximizing the surgeons’ ability to remove all cancer sites and thus patients’ outcomes. Sentinel node biopsy (SNB) represents an imaging-guided technique that could enhance nodal staging accuracy by leveraging lymphatic mapping with tracers. PSMA-RGS uses radiolabeled tracers with the aim to improve intraoperative lymph node metastases (LNMs) detection. Several studies demonstrated its feasibility and safety, with promising accuracy in nodal staging during robot-assisted radical prostatectomy (RARP) and in recurrence setting during salvage lymph node dissection (sLND) in patients who experience biochemical recurrence (BCR) after primary treatment and have positive PSMA positron emission tomography (PET). Near-infrared PSMA tracers, such as OTL78 and IS-002, have shown potential in intraoperative fluorescence-guided surgery, improving positive surgical margins (PSMs) and LNMs identification. Finally, augmented reality (AR), which integrates preoperative imaging (e.g., multiparametric magnetic resonance imaging [mpMRI] of the prostate and computed tomography [CT]) onto the surgical field, can provide a real-time visualization of anatomical structures through the creation of three-dimensional (3D) models. These technologies may assist surgeons during intraoperative procedures, thus optimizing the balance between oncological control and functional outcomes. However, challenges remain in standardizing these tools and assessing their impact on long-term PCa control. Overall, these advancements represent a paradigm shift toward personalized and precise surgical approaches, emphasizing the integration of innovative strategies to improve outcomes of PCa patients.
新兴的影像引导技术，如前列腺特异性膜抗原放射引导手术（PSMA-RGS）和增强现实（AR），有望提升机器人辅助前列腺癌（PCa）手术方法的精确性和有效性，从而最大限度地增强外科医生切除所有癌灶的能力，并改善患者预后。前哨淋巴结活检（SNB）作为一种影像引导技术，通过利用示踪剂进行淋巴绘图，可提高淋巴结分期的准确性。PSMA-RGS使用放射性标记的示踪剂，旨在改善术中淋巴结转移（LNMs）的检测。多项研究已证明其在机器人辅助根治性前列腺切除术（RARP）中淋巴结分期，以及在初次治疗后出现生化复发（BCR）且PSMA正电子发射断层扫描（PET）阳性的患者中进行挽救性淋巴结清扫（sLND）时淋巴结分期中的可行性和安全性，并显示出良好的准确性。近红外PSMA示踪剂，如OTL78和IS-002，在术中荧光引导手术中显示出潜力，可改善阳性手术切缘（PSMs）和淋巴结转移的识别。最后，增强现实（AR）通过将术前影像（如前列腺多参数磁共振成像[mpMRI]和计算机断层扫描[CT]）整合到手术视野中，并通过创建三维（3D）模型提供解剖结构的实时可视化。这些技术可在术中协助外科医生，从而优化肿瘤控制与功能预后之间的平衡。然而，这些工具的标准化及其对长期前列腺癌控制影响的评估仍面临挑战。总体而言，这些进展代表了向个性化和精准手术方法的范式转变，强调了整合创新策略以改善前列腺癌患者预后的重要性。
The Role of Robot-Assisted, Imaging-Guided Surgery in Prostate Cancer Patients
肿瘤(癌症)患者之家