Rapid discrimination of high-grade prostate cancer using label-free fluorescence lifetime measurement in biopsy specimens

Standard prostate biopsies suffer from high false negative rates and grade underestimation, creating an urgent need for improved tissue assessment. This study demonstrates the ability of label-free Fluorescence Lifetime Imaging (FLIm) for discriminating high-grade prostate cancer in ex vivo biopsy specimens immediately after collection. Using a single-fiber system for excitation delivery and fluorescence collection across four spectral bands, we achieved ROC-AUC of 0.88 for identifying Grade ≥4 cancer with 79.3%/85.0% sensitivity/specificity in specimens from 20 patients. These results establish FLIm as a promising modality for integration into next-generation optically-guided biopsy systems that provide real-time tissue feedback.