Real-Time Identification of Nodal Metastases With 99mTc–Prostate-Specific Membrane Antigen–Based Radioguidance and Indocyanine Green Fluorescence Imaging in Primary Prostate Cancer Surgery—On the Road to Hybrid Image-Guided Surgery

Abstract Recent developments in image-guided prostate cancer surgery focus on extending prostate-specific membrane antigen–directed radioguidance with optical tumor detection using fluorescence, as radio- and fluorescence signals complement each other with in-depth detection and real-time visualization, respectively. As a step in this direction, we report here the integration of indocyanine green fluorescence imaging into a 99m Tc–prostate-specific membrane antigen–targeted radioguided surgery workflow.