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15.11.2016 | Original Article

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

verfasst von: 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

Erschienen in: World Journal of Urology | Ausgabe 7/2017

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Abstract

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.

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Titel: First report of robot-assisted transperineal fusion versus off-target biopsy in patients undergoing repeat prostate biopsy
verfasst von: 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
Publikationsdatum: 15.11.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 7/2017
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-016-1970-8

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