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

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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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Authors’ contribution

SK was involved in protocol development, data collection, data analysis and manuscript writing/editing. JM, BA, SR, MA, MS, FF, UK and MN took part in data collection and manuscript editing. KN and AS carried out protocol development, data collection and manuscript editing. JB performed protocol development, data analysis, manuscript editing and supervision of study. SK conducted protocol development, data collection, data analysis and manuscript writing/editing.

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Authors and Affiliations

  1. Department of Urology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany

    S. Kaufmann, J. Mischinger, B. Amend, S. Rausch, M. Adam, A. Stenzl, J. Bedke & S. Kruck

  2. Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen, Germany

    S. Kaufmann, U. Kramer, M. Notohamiprodjo & K. Nikolaou

  3. Institute of Pathology, Eberhard Karls University, Tuebingen, Germany

    M. Scharpf & F. Fend

Authors
  1. S. Kaufmann
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  2. J. Mischinger
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  3. B. Amend
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  4. S. Rausch
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  5. M. Adam
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  6. M. Scharpf
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  8. U. Kramer
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  9. M. Notohamiprodjo
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  10. K. Nikolaou
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  11. A. Stenzl
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  12. J. Bedke
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  13. S. Kruck
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Corresponding author

Correspondence to J. Bedke.

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Conflict of interest

Authors Kruck S has received a travel grant from Biobot Surgical (Singapore) to the Urological Association of Asia Congress 2016. The other authors declare that they have no conflict of interest.

Ethical standards

The study was approved by the institutional review board and conducted in accordance with the Helsinki and START protocol. We take responsibility for the integrity of the data and the accuracy of the reported study. All authors have made a substantial contribution to the information or material submitted for publication and approved the final version.

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Kaufmann, S., Mischinger, J., Amend, B. et al. First report of robot-assisted transperineal fusion versus off-target biopsy in patients undergoing repeat prostate biopsy. World J Urol 35, 1023–1029 (2017). https://doi.org/10.1007/s00345-016-1970-8

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  • DOI: https://doi.org/10.1007/s00345-016-1970-8

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