In the landscape of modern surgical practices, particularly in the field of oncology, accurate determination of tumor margins has emerged as a critical factor influencing patient outcomes. Radical prostatectomy is considered a standard curative measure for high-risk prostate cancer. However, this procedure is fraught with challenges, especially when it comes to ensuring that the surgical excision is complete in high-grade malignant tumors. Particularly, tumors classified within the Gleason grade group (GG) of 3 and above present significant risks for residual malignancy, contributing to postoperative complications that can severely impact a patient’s quality of life.
One of the most significant challenges faced by surgeons during prostate cancer surgeries is the real-time identification of cancerous tissues, particularly those that exhibit aggressive characteristics. Traditional methods rely on ex vivo analysis and histopathological evaluation, which prove inadequate during the time-sensitive nature of surgery. In concert with the latest technological advances, a novel approach has been developed that could revolutionize the way intraoperative assessments are conducted. Researchers have introduced a surface-enhanced Raman scattering (SERS)-based navigation system, designed to assist surgeons in accurately localizing high-grade malignant regions during radical prostatectomy.
The SERS-based navigation system stands out due to its capability to simultaneously assess two critical biological markers: tissue acidity and prostate-specific antigen (PSA) enzymatic activity. The rationale for focusing on these parameters is rooted in their established role in distinguishing between benign and malignant tissues. An increased acidity in tumor tissues and elevated PSA levels are consistent indicators of malignancy, particularly in aggressive forms of prostate cancer. By capturing and quantifying these markers in real-time, the SERS system aims to enhance surgical precision, ultimately reducing the incidence of positive surgical margins.
Central to the functionality of this innovative system is the incorporation of a specialized sampling pen that facilitates the automated extraction of biomarker data directly from the surface of the tissue. This tool eliminates the need for extensive manual sampling, thereby streamlining the process of data collection. Once the biomarkers have been collected, the system employs a nano-imprinted SERS array that generates a ratiometric Raman signal, providing insights into both the acidity levels and PSA activity of the extracted tissue samples. This dual-layered analysis ensures a comprehensive understanding of the tissue’s biological state, offering valuable guidance to the surgical team.
To interpret the complex Raman spectral data generated by this system in real time, researchers have developed a sophisticated two-dimensional deep learning model. This model is trained to recognize patterns in the spectral data that correlate with different Gleason grade classifications. By employing advanced machine learning techniques, the system can quickly provide feedback on the malignancy level of the tissue being assessed, aiding surgeons in making informed decisions during the procedure.
The SERS-based navigation system has undergone rigorous testing to evaluate its effectiveness. In a clinical study involving fresh prostate tissues from 144 Chinese patients, the system demonstrated robust performance, achieving an area under the receiver operating characteristic curve (AUC) of 0.89 for distinguishing GG ≥ 3 malignancies. Such a high level of sensitivity and specificity is critical in the surgical setting, where any misjudgment could lead to either overtreatment or undertreatment of cancer.
Moreover, this system offers potential advantages beyond mere diagnostic capabilities. By facilitating real-time identification of high-grade malignancies, it equips surgeons with the necessary tools to minimize tumor residue and improve surgical outcomes. The implications of this technology are profound: reducing the likelihood of recurrence, decreasing the need for additional therapies, and ultimately enhancing the long-term survival rates for patients afflicted with aggressive prostate cancer.
In a field where precision and speed are paramount, the integration of SERS technology into surgical practices not only optimizes intraoperative decision-making but also aligns with the broader trend of personalized medicine. As we continue to unravel the intricacies of cancer biology, the ability to tailor surgical interventions based on real-time molecular insights could pave the way for more successful treatment strategies and improved patient prognoses.
While the SERS-based navigation system represents a significant leap forward in cancer surgery, challenges remain regarding its broader implementation. Questions surrounding the scalability of the technology, the need for standardized protocols among different healthcare facilities, and the costs associated with integrating advanced technologies into surgical suites must be addressed. However, as this innovative approach gains traction, it holds the promise of transforming how prostate cancer surgeries are conducted, setting a new standard in the quest for accuracy in surgical oncology.
Moreover, the potential applications of SERS technology extend beyond prostate cancer. The principles underlying this navigation system could be adapted to other malignancies, making it a versatile tool in the surgeon’s arsenal. Future research may focus on refining the technology, expanding its applicability, and potentially integrating it with other diagnostic imaging modalities. Such advancements could lead to a significant paradigm shift in how cancers are detected, diagnosed, and treated, ultimately reshaping the future of surgical oncology.
As we stand at the forefront of these exciting developments, it is imperative for the medical community to remain vigilant in embracing such innovations. Enhanced training for surgical teams, the establishment of collaborative research initiatives, and continued investment in biomedical engineering will be crucial in harnessing the full potential of this groundbreaking technology. By fostering an environment of innovation and collaboration, we can take meaningful steps toward improving patient outcomes and advancing the field of cancer care.
In conclusion, the SERS-based navigation system represents a remarkable progress in the surgical oncology toolkit. By enabling real-time, label-free characterization of high-grade malignant tissues, it holds the potential to significantly mitigate the risks associated with radical prostatectomy. As research continues and the technology matures, we can look forward to a future where surgical precision is enhanced, patient safety is prioritized, and the goals of cancer treatment may be achieved more effectively than ever before.
Subject of Research: Surface-enhanced Raman scattering (SERS) navigation system for prostate cancer surgery.
Article Title: Label-free navigation system for grading prostate tumour malignancy in situ via tissue pH and prostate-specific antigen activity.
Article References:
Jin, Z., Chen, S., Dong, X. et al. Label-free navigation system for grading prostate tumour malignancy in situ via tissue pH and prostate-specific antigen activity.
Nat. Biomed. Eng (2025). https://doi.org/10.1038/s41551-025-01561-y
Image Credits: AI Generated
DOI: https://doi.org/10.1038/s41551-025-01561-y
Keywords: Prostate cancer, surface-enhanced Raman scattering, intraoperative navigation, surgical precision, Gleason grade.
