Intraoperative assessment of surgical margins during radical prostatectomy: advances and challenges

PURPOSE OF REVIEW: Detection of positive surgical margins during radical prostatectomy is critical to minimizing the risk of prostate cancer recurrence. This review deals with established methods, recent advances in real-time intraoperative technologies, and future directions in margin assessment. RECENT FINDINGS: This review examines traditional methods, real-time technologies, and prospects in intraoperative margin assessment. It is based on questions put forward by patients and patient advocates (or representatives) and related to achieving negative surgical margins (SMs). The answers are given by uropathologists. This review focuses on intraoperative frozen section (IFS) of surgical margins and fluorescence confocal microscopy (FCM) and, to a less extent, on real-time augmented reality (AR), and intraoperative margin assessment with prostate-specific membrane antigen (PSMA). Innovations in intraoperative imaging and tissue analysis are enhancing the detection of tumor involvement not only at the prostate surface but also within the surrounding periprostatic tissues. SUMMARY: These technologies, particularly when integrated with artificial intelligence, are poised to transform the surgical management of prostate cancer by enabling more precise and individualized treatment strategies.