Modern methods of intraoperative control of positive surgical margin in prostate cancer

Introduction. The presence of a positive surgical margin (PSM) in a specific group of patients after radical prostatectomy (RP) remains an important and unresolved issue, affecting cancer-specific survival and progression-free survival. The aim. To highlight the current state of the problem and available methods to reduce the risk of PSM occurrence. Materials and Methods. A literature search was conducted using the databases PubMed, The Cochrane Library, and eLibrary with the following keywords: prostate cancer, radical prostatectomy, nerve-sparing prostatectomy, positive surgical margin, intraoperative methods of monitoring positive surgical margins. Over 80 scientific works published in the last 20 years were identified and studied, of which 51 were included in this review. Results. The analyzed materials revealed conflicting results regarding the effectiveness of existing intraoperative monitoring methods for positive surgical margins (PSM) in prostate cancer (PCa). The most studied method is intraoperative histological examination of frozen sections of prostate tissue, which statistically reduces the detection rate of PSM; however, most studies do not demonstrate a significant improvement in cancer-specific survival when using this technique. Promising directions for intraoperative PSM control include various spectroscopic and microscopic techniques that require further investigation and clinical implementation. The most promising approach is intraoperative PSM assessment using prostatespecific membrane antigen (PSMA), which, considering its proven success in the diagnosis and therapy of PCa, could significantly improve oncological outcomes in patients who undergo radical prostatectomy. Conclusions. The high prevalence of PSM in the population of patients who have undergone RP, despite the availability of numerous modern intraoperative control methods for PSM, remains an unresolved issue that affects long-term oncological outcomes. Further research into existing strategies for controlling PSM is necessary, along with a parallel search for new promising solutions to this problem.