Diagnostic accuracy and clinical implications of robotic assisted MRI-US fusion guided target saturation biopsy of the prostate

Christian Wetterauer,Hans Helge Seifert,Pawel Trotsenko,Anja Meyer,Christian Breit,Tatjana Vlajnic,Nicola Keller,David Jean Winkel,Philipp Brantner,Lukas Bubendorf,Marc Olivier Matthias,Maciej Kwiatkowski

doi:10.1038/s41598-021-99854-0

Christian Wetterauer, Hans Helge Seifert + Show 10 more

Open Access

https://doi.org/10.1038/s41598-021-99854-0

Copy DOI

Abstract

MRI-targeted prostate biopsy improves detection of clinically significant prostate cancer (PCa). However, up to 70% of PCa lesions display intralesional tumor heterogeneity. Current target sampling strategies do not yet adequately account for this finding. This prospective study included 118 patients who underwent transperineal robotic assisted biopsy of the prostate. We identified a total of 58 PCa-positive PI-RADS lesions. We compared diagnostic accuracy of a target-saturation biopsy strategy to accuracy of single, two, or three randomly selected targeted biopsy cores and analysed potential clinical implications. Intralesional detection of clinically significant cancer (ISUP ≥ 2) was 78.3% for target-saturation biopsy and 39.1%, 52.2%, and 67.4% for one, two, and three targeted cores, respectively. Target-saturation biopsies led to a more accurate characterization of PCa in terms of Gleason score and reduced rates of significant cancer missed. Compared to one, two, and three targeted biopsy cores, target-saturation biopsies led to intensified staging procedures in 21.7%, 10.9, and 8.7% of patients, and ultimately to a potential change in therapy in 39.1%, 26.1%, and 10.9% of patients. This work presents the concept of robotic-assisted target saturation biopsy. This technique has the potential to improve diagnostic accuracy and thus individual staging procedures and treatment decisions.

Highlights

Worldwide, prostate cancer (PCa) is the second most common cancer in men, and the second most common cause of cancer d eaths[1]
Performance of prostate biopsies with utmost precision in an automated fashion and facilitate exact planning and execution of biopsy strategies in a 2-dimensional and a 3-dimensional fashion[16]. This technique provides the prerequisites to test the diagnostic yield of a new target saturation biopsy strategy in terms of providing representative samples of suspicious lesions for accurate identification and classification of PCa
This study aims to assess the potential of robotic-assisted target saturation biopsies in terms of intra-lesional diagnostic accuracy as well as its potential clinical implications

Summary

Introduction

Prostate cancer (PCa) is the second most common cancer in men, and the second most common cause of cancer d eaths[1]. Performance of prostate biopsies with utmost precision in an automated fashion and facilitate exact planning and execution of biopsy strategies in a 2-dimensional and a 3-dimensional fashion[16]. This technique provides the prerequisites to test the diagnostic yield of a new target saturation biopsy strategy in terms of providing representative samples of suspicious lesions for accurate identification and classification of PCa. This study aims to assess the potential of robotic-assisted target saturation biopsies in terms of intra-lesional diagnostic accuracy as well as its potential clinical implications

Objectives

Methods

Results

Conclusion