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‘‘ How can I reduce my positive surgical margin rate?’’ This is a common refrain from the urologist performing radical prostatectomy (RP) for localized prostate cancer (PC). Avoidance of positive surgical margins (PSMs) during RP is important to reduce the likelihood of biochemical recurrence and the subsequent increased risk of metastases and death from PC (1). PSMs increase the likelihood of receiving additional treatment such as pelvic radiotherapy by up to 5-fold (2), as well as increasing the likelihood of local morbidity and the financial burden of additional treatment. Despite advancements in surgical technologies, a 2017 metaanalysis found that the rate of PSMs for open RP was 31.4% (range, 21%–53%), and the rate of PSMs for robot-assisted RP was similar, at 31.7% (range, 14%–50%) (3). Currently, options for surgeons to prevent PSMs are limited and include preoperative and intraoperative strategies. Regarding the former, traditional risk stratification is based on characteristics such as digital rectal examination, multiparametric MRI, biopsy findings, and, more recently, PSMA PET/CT (4). However, these studies are often performed many months before surgery and the true pathology can advance in the interval. Intraoperative techniques such as fresh-frozen sections may be used for intraoperative assessment; however, there remain concerns about high rates of false-negatives (5). Recently, fresh-frozen sections have been incorporated into the NeuroSAFE principle aimed at improving functional outcomes by facilitating preservation of neurovascular bundles when there is uncertainty about a tumor breach into these regions (6). However, we await level 1 evidence to support worldwide use of this method, and limitations in pathology resources and expertise will persist regardless of the data supporting fresh-frozen sections to reduce margins. Therefore, additional strategies to reduce PSM rates are welcome.

Cerenkov Luminescence Imaging for Surgical Margins in Radical Prostatectomy: A Surgical Perspective