Label-free fluorescence lifetime imaging for rapid discrimination of high-grade prostate cancer in fresh biopsy cores: a feasibility study.

Significance: Prostate biopsy remains the gold standard for prostate cancer (PCa) diagnosis and treatment planning. However, current techniques suffer from low cancer detection rates, with most biopsy cores sampling benign tissue, leading to undergrading and repeat procedures. Label-free fluorescence lifetime imaging (FLIm) offers a potential solution by enabling real-time discrimination between malignant and benign tissue during biopsy collection, potentially reducing both the number of cores required and the repeat biopsy rates. Aim: This pilot study evaluates the feasibility of label-free FLIm for rapid discrimination of malignant from benign prostate tissue in freshly obtained core needle biopsies. Approach: Twenty patients undergoing prostate biopsy were enrolled. FLIm measurements were performed immediately after sample collection ( Results: Separation between benign tissue and Gleason pattern Conclusions: FLIm demonstrates strong potential for identifying high-grade PCa. Because measurements were performed using a single fiber optic, this approach can be readily integrated into standard prostate biopsy devices to enable FLIm-guided and real-time tissue characterization during the biopsy procedure and to inform targeted tissue collection.