title: Photodynamic diagnosis of positive margin during radical prostatectomy: preliminary experience with 5-aminolevulinic acid.
abstract: OBJECTIVE
  To investigate the feasibility of intraoperative photodynamic diagnosis (PDD) by 5-aminolevulinic acid (ALA) for the identification of positive surgical margins (PSM) during retropubic radical prostatectomy (RRP) in patients with prostate cancer (PCa).
  
  
  METHODS
  Intraoperative PDD was carried out in 16 patients with pathologically confirmed PCa by biopsy of the apex, or carrying >25% of probability of extraprostatic extension as defined by Japan PC Table. Before operation, 1.0 g of ALA was given orally. During open RRP, the resection margins inside the body were examined by PDD system with a fluorescence laparoscope. After their removal, 12 harvested prostates were divided and also investigated by PDD. Red fluorescent-positive lesions were biopsied and compared with the pathological result.
  
  
  RESULTS
  All 16 patients were fluorescence-negative inside the body, and negative margins were pathologically confirmed during PDD. Among the 43 specimens of 12 cases obtained by biopsy under PDD, 11 specimens (25.6%) were pathologically diagnosed as malignant tissue (adenocarcinoma, 10 specimens; high grade prostatic intraepithelial neoplasia, 1 specimen) and 19 specimens (44.2%) were evaluated as positive fluorescence by PDD with a sensitivity of 81.8%, a specificity of 68.8% and a predictive accuracy of 72.1%. No side-effects were observed and the procedures were well tolerated.
  
  
  CONCLUSIONS
  PDD mediated by ALA during RRP might be a feasible and safe modality for detection of surgical margins. Further prospective randomized studies with larger populations are required.
authors.affiliation: Department of Urology, Kochi Medical School, Kochi, Japan. jm-fukuhara@kochi-u.ac.jp
authors.forename: Hideo
authors.initials: H
authors.lastname: Fukuhara
authors.forename: Keiji
authors.initials: K
authors.lastname: Inoue
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Satake
authors.forename: Kenji
authors.initials: K
authors.lastname: Tamura
authors.forename: Takashi
authors.initials: T
authors.lastname: Karashima
authors.forename: Ichiro
authors.initials: I
authors.lastname: Yamasaki
authors.forename: Iiyama
authors.initials: I
authors.lastname: Tatsuo
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kurabayashi
authors.forename: Mutsuo
authors.initials: M
authors.lastname: Furihata
authors.forename: Taro
authors.initials: T
authors.lastname: Shuin
mesh_terms: D000368:Aged; D000622:Aminolevulinic Acid; D003950:Diagnostic Techniques, Urological; D005240:Feasibility Studies; D005453:Fluorescence; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D017319:Photosensitizing Agents; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid