Systematic Review and Meta-Analysis of Free-Hand and Fixed-Arm Spatial Tracking Methodologies in Software-Guided MRI-TRUS Fusion Prostate Biopsy Platforms.

To evaluate the cancer detection rate (CDR) between the two dominant spatial tracking methodologies in software-guided MRI-transrectal ultrasound fusion prostate biopsy (SGF-Bx) platforms: fixed-arm and free-hand.

We conducted a systematic review and meta-analysis on published primary analyses of prospective trials and cohort studies that enrolled biopsy-naïve patients for SFG-Bx. Inclusion criteria included the use of the Prostate Imaging Reporting & Data System (PI-RADS) v2.0 or later and the targeting of lesions graded as PI-RADS 3 or higher. Random effects models were used to assess the overall prostate cancer (PCa) CDR and the clinically significant prostate cancer (csPCa) CDR for both platforms. csPCa was standardized to a definition of Gleason Grade Group 2 or higher when possible. Subgroup analysis was performed by stratifying studies into the average number of cores taken per lesion.

The PCa CDR was 0.674 for free-hand systems and 0.681 for fixed-arm systems. The csPCa CDR was 0.492 for free-hand systems and 0.500 for fixed-hand systems. There was no significant difference between free-hand and fixed-arm cancer detection rates for both overall PCa (p=0.88) and csPCa (p=0.90). Subgroup analyses revealed significant PCa CDR and csPCa CDR differences (p<0.001) between free-hand and fixed-arm platforms only when 2 cores per lesion were taken, in favor of fixed-arm platforms.

Fixed-arm platforms performed similarly in cancer detection to free-hand platforms but show a minor benefit on fewer samples. While tracking methodology differences appear subtle, further investigation into the clinical impact of platform-specific features are warranted.

Urology. 2022 Oct 12 [Epub ahead of print]

Calvin C Zhao, Juan Kochen Rossi, James S Wysock

Department of Urology, Stanford University School of Medicine, Palo Alto, CA., Department of Urology, New York University Grossman School of Medicine, New York, New York., Department of Urology, New York University Grossman School of Medicine, New York, New York. Electronic address: .