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

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.

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.

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.

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.

World journal of urology. 2016 Nov 15 [Epub ahead of print]

S Kaufmann, J Mischinger, B Amend, S Rausch, M Adam, M Scharpf, F Fend, U Kramer, M Notohamiprodjo, K Nikolaou, A Stenzl, J Bedke, S Kruck

Department of Urology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany., Institute of Pathology, Eberhard Karls University, Tuebingen, Germany., Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen, Germany., Department of Urology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany. .

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