First report of robot-assisted transperineal fusion versus off-target biopsy in patients undergoing repeat prostate biopsy

• Published in: World journal of urology 2017-07, Vol.35 (7), p.1023-1029
• Main Authors: Kaufmann, S., Mischinger, J., Amend, B., Rausch, S., Adam, M., Scharpf, M., Fend, F., Kramer, U., Notohamiprodjo, M., Nikolaou, K., Stenzl, A., Bedke, J., Kruck, S.
• Format: Article
• Language: English
• Subjects: Aged; Biopsy; Cancer surgery; Humans; Image-Guided Biopsy - instrumentation; Image-Guided Biopsy - methods; Imaging, Three-Dimensional - methods; Magnetic resonance imaging; Magnetic Resonance Imaging - instrumentation; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Grading; Nephrology; NMR; Nuclear magnetic resonance; Oncology; Original Article; Prostate - diagnostic imaging; Prostate - pathology; Prostate cancer; Prostatectomy; Prostatectomy - methods; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - pathology; Reproducibility of Results; Robotics - methods; Robots; Ultrasonography, Interventional - instrumentation; Ultrasonography, Interventional - methods; Ultrasound; Urological surgery; Urology
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-016-1970-8

Purpose To clarify the value of targeted versus off-target biopsies in men with a suspicion of prostate cancer (PC) and a visible lesion in multi-parametric magnetic resonance imaging (mpMRI) using transperineal robot-assisted biopsy. Methods Fifty-five consecutive men with one non-palpable suspicious lesion in mpMRI after negative 12-core transrectal ultrasound-guided biopsy were enrolled in 2014–2015. Lesions were scored using the Prostate Imaging Reporting and Data System. A robot-assisted system was utilized to collect four robot-assisted targeted transperineal biopsy cores (RA-TB) within the lesion using mpMRI–TRUS elastic fusion. Untargeted transperineal 14-core biopsy was performed only outside the lesion (RA-UB). Histological grade was compared in biopsies and available prostatectomy specimens. Results Overall, 34 of 55 patients (62%) were diagnosed with PC based on biopsy. 85% of cancers were clinically significant PC (csPC) defined as GS ≥ 7. 85% of biopsy-proven cancers were detected with RA-TB alone. RA-UB identified only one additional patient with csPC and lead to upgrading in five biopsy cases (14.7%). Pathological evaluation of 14 prostatectomy specimens showed upgrading in 2 patients (14.3%), while all other patients were correctly classified by RA-TB without need of additional RA-UB. Mean procedure duration was 43 (±6) min, and only minor complications according to Clavien–Dindo were recorded during 30-day follow-up. Conclusions This is the first report of transperineal robot-assisted elastic mpMRI–TRUS fusion biopsy. RA-TB of positive MR lesions enabled reliable detection of csPC, while RA-UB in MRI-negative regions is of minor importance.