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Abstract
Robotic prostate biopsy is an emerging technology. Recent development of this tool has allowed the performance of a transperineal prostate biopsy allowing pre-programmed standardized biopsy schemes. Prospective data collection was undertaken in 86 consecutive men who underwent robotically assisted transperineal prostate biopsy. All underwent a multi-parametric MRI pre-biopsy with centroid targeting followed by systematic template prostate biopsy. For the purposes of this study, our definition of clinically significant prostate cancer (csPCa) is any Gleason score > 6. Mean (SD) age, median (IQR) PSA, and median (IQR) prostate volume were 64.24 (6.97) years, of 7.79 ng/ml (6.5) and 45.06 cc (28), respectively. Overall, 44 (51.2%) men were diagnosed with csPCa. csPCa was detected in the targeted biopsies alone in 35 (40.1%) men. The addition of the 12-zone template biopsy increased the yield of csPCa for another 9 (10.5%) men. Of these 9 men, the majority (7) harbored primary pattern 3 disease and only 1 was identified to have high-grade disease. Out of these 9 men, 7 of them had the identification of csPCa in the sector, where a target was contained within that zone. Robotic-assisted prostate biopsy in our study has demonstrated a high detection of csPCa when combined with limited near-field sampling. Our study suggests the use of more accurate biopsy schemes such as ring-targeting of lesions to mitigate against systematic and random mathematical errors. Adoption of this tool and biopsy strategy would potentially avoid the increased morbidity associated with whole gland systematic unguided biopsies.
Highlights
Prostate cancer remains a significant health burden and cause of male mortality
Our primary evaluation is the detection of clinically significant prostate cancer with robotic centroid targeting versus 12 sector systematic TP biopsy
No man had more than 3 target lesions identified in the pre-biopsy multi-parametric MRI (mpMRI) with a median (IQR) number of targeted biopsy per
Summary
Prostate cancer remains a significant health burden and cause of male mortality. Detection of prostate cancer has evolved from blind systematic transrectal biopsies to MRI lesion directed transperineal biopsy including robotic approach such as employed here [1]. The TP prostate biopsy does, have a steeper learning curve and when coupled with a pre-biopsy MRI requires potential additional soft- and hardware to allow MRI-US fusion. One such strategy to address and allow greater implementation of targeted TP prostate biopsy is the use of a robotic tool. Ring targeting involves creating a ring around the suspected tumor where targets are spaced at equal arc lengths on the ring Targeting strategies such as centroid versus ring targeting to mitigate against such errors on the robotic platform are yet to be addressed or investigated. Our primary evaluation is the detection of clinically significant prostate cancer (csPCa) with robotic centroid targeting versus 12 sector systematic TP biopsy
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