Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Apr 23;17(9):1401.
doi: 10.3390/cancers17091401.

The Role of Robot-Assisted, Imaging-Guided Surgery in Prostate Cancer Patients

Leonardo Quarta  1 , Donato Cannoletta  1 , Francesco Pellegrino  1 , Francesco Barletta  1 , Simone Scuderi  1 , Elio Mazzone  1 , Armando Stabile  1 , Francesco Montorsi  1   2 , Giorgio Gandaglia  1   2 , Alberto Briganti  1   2
Affiliations
Review

The Role of Robot-Assisted, Imaging-Guided Surgery in Prostate Cancer Patients

Leonardo Quarta et al. Cancers (Basel). .

Abstract

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.

Keywords: augmented reality; near-infrared PSMA tracers; prostate cancer; prostate-specific membrane antigen; radioguided surgery; sentinel node biopsy.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Falagario U.G., Knipper S., Pellegrino F., Martini A., Akre O., Egevad L., Grönberg H., Moschovas M.C., Bravi C.A., Tran J., et al. Prostate Cancer–specific and All-cause Mortality After Robot-assisted Radical Prostatectomy: 20 Years’ Report from the European Association of Urology Robotic Urology Section Scientific Working Group. Eur. Urol. Oncol. 2023;7:705–712. doi: 10.1016/j.euo.2023.08.005. - DOI - PubMed
    1. Preisser F., Marchioni M., Nazzani S., Bandini M., Tian Z., Pompe R.S., Montorsi F., Saad F., Abdollah F., Steuber T., et al. The Impact of Lymph Node Metastases Burden at Radical Prostatectomy. Eur. Urol. Focus. 2019;5:399–406. doi: 10.1016/j.euf.2017.12.009. - DOI - PubMed
    1. Martini A., Gandaglia G., Fossati N., Scuderi S., Bravi C.A., Mazzone E., Stabile A., Scarcella S., Robesti D., Barletta F., et al. Defining Clinically Meaningful Positive Surgical Margins in Patients Undergoing Radical Prostatectomy for Localised Prostate Cancer. Eur. Urol. Oncol. 2019;4:42–48. doi: 10.1016/j.euo.2019.03.006. - DOI - PubMed
    1. de Rooij M., Hamoen E.H., Witjes J.A., Barentsz J.O., Rovers M.M. Accuracy of Magnetic Resonance Imaging for Local Staging of Prostate Cancer: A Diagnostic Meta-analysis. Eur. Urol. 2016;70:233–245. doi: 10.1016/j.eururo.2015.07.029. - DOI - PubMed
    1. Gandaglia G., Ploussard G., Valerio M., Mattei A., Fiori C., Roumiguié M., Fossati N., Stabile A., Beauval J.-B., Malavaud B., et al. The Key Combined Value of Multiparametric Magnetic Resonance Imaging, and Magnetic Resonance Imaging–targeted and Concomitant Systematic Biopsies for the Prediction of Adverse Pathological Features in Prostate Cancer Patients Undergoing Radical Prostatectomy. Eur. Urol. 2020;77:733–741. doi: 10.1016/j.eururo.2019.09.005. - DOI - PubMed

LinkOut - more resources