title: Performance of 5-aminolevulinic-acid-based photodynamic diagnosis for radical prostatectomy.
abstract: BACKGROUND
  The aim of this study was to investigate whether we could detect positive surgical margins during open and laparoscopic radical prostatectomy by 5-aminolevulinic acid (ALA) photodynamic diagnosis (PDD) and mapping of red fluorescence in human prostate cancer cells.
  
  
  METHODS
  All 52 patients were diagnosed with prostate cancer by biopsy. They had a positive core in the apex or highly suspicious positive margins. Open and laparoscopic radical prostatectomy was performed in 18 and 34 cases, respectively. One gram of ALA solution was given intraoperatively, orally through a stomach tube. An endoscopic PDD system, including a D-Light C, CCU Tricam SLII/3CCD CH Tricam-P PDD, and HOPKINS II Straight Forward Telescope 0°, was used. The D-Light C light source was equipped with a band-pass filter. The CCU Tricam SLII/3CCD CHTricam-P PDD video camera system was equipped with a long-pass filter. The laparoscopy optic component was equipped with a yellow long-pass filter.
  
  
  RESULTS
  One of the 52 patients had a red-fluorescent-positive margin of the excised whole prostate and the positive surgical margin was histologically confirmed. In the section of excised prostate, we obtained 141 biopsied samples. The sensitivity and specificity were 75.0% and 87.3%, respectively.
  
  
  CONCLUSIONS
  Intraoperative ALA-PDD is feasible. However, heat degeneration and length of positive surgical margin have crucial influences on red fluorescence. In future, a randomized clinical trial should be carried out.
authors.affiliation: Department of Urology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, Japan. jm-fukuhara@kochi-u.ac.jp.
authors.forename: Hideo
authors.initials: H
authors.lastname: Fukuhara
authors.affiliation: Department of Urology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, Japan. keiji@kochi-u.ac.jp.
authors.forename: Keiji
authors.initials: K
authors.lastname: Inoue
authors.affiliation: Department of Pathology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, Japan. kurabaya@kochi-u.ac.jp.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kurabayashi
authors.affiliation: Department of Pathology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, Japan. furiham@kochi-u.ac.jp.
authors.forename: Mutsuo
authors.initials: M
authors.lastname: Furihata
authors.affiliation: Department of Urology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, Japan. shuint@kochi-u.ac.jp.
authors.forename: Taro
authors.initials: T
authors.lastname: Shuin
mesh_terms: D000368:Aged; D000622:Aminolevulinic Acid; D003287:Contrast Media; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008856:Microscopy, Fluorescence / Q000379:methods; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D000622:Aminolevulinic Acid