Multiparametric MRI‐ultrasonography software fusion prostate biopsy: initial results using a stereotactic robotic‐assisted transperineal prostate biopsy platform comparing systematic vs targeted biopsy

Abstract

To compare the detection rates of prostate cancer between systematic biopsy and targeted biopsy using a stereotactic robotassisted transperineal prostate platform. Materials and Methods We identified consecutive patients with suspicious lesion(s) on multiparametric magnetic resonance imaging (mpMRI), who underwent both systematic and MRI-transrectal ultrasonography (US) fusion targeted biopsy using our proprietary transperineal robot-assisted prostate biopsy platform between January 2015 and January 2019 at our institution, for retrospective analysis. Comparative analysis was performed between systematic and targeted biopsy using McNemar's test, and the cohort was further stratified by prior biopsy status and Prostate Imaging Reporting and Data System (PI-RADS) v2.0 score. International Society of Urological Pathology (ISUP) grade group (GG) ≥2 cancers (previously known as Gleason grade ≥7) were considered to be clinically significant. Results A total of 500 patients were included in our final analysis, of whom 67 (13%) were patients with low-risk cancer on active surveillance. Of the 433 patients without prior diagnosis of cancer, 288 (67%) were biopsy-na€ ıve. A total of 248 (57%) were diagnosed with prostate cancer, with 199 (46%) having clinically significant prostate cancer (ISUP GG ≥2). There were no statistically significant differences in the overall prostate cancer and clinically significant prostate cancer detection rate between systematic and targeted biopsy (51% vs 49% and 40% vs 38% respectively; P = 0.306 and P = 0.609). Of the 248 prostate cancers detected, 75% (187/248) were detected on both systematic and targeted biopsy, 14% (35/248) were detected on systematic biopsy alone and 11% (26/248) were detected on targeted biopsy alone. Of the 199 clinically significant cancers detected, 69% (138/199) were detected on both systematic and targeted biopsy, 17% (33/199) on systematic biopsy alone and 14% (28/199) on targeted biopsy alone. There were no statistically significant differences in the detection rate between systematic and targeted biopsy for both overall and clinically significant prostate cancer, even when the cohort was stratified by prior biopsy status and PI-RADS score. Targeted biopsy has greater sampling efficiency compared to systematic biopsy for both overall and clinically significant prostate cancer (23.2% vs 9.8%, P < 0.001 and 14.8% vs 5.6%, P < 0.001). Conclusions Using our robot-assisted transperineal prostate platform, combined MRI-US targeted biopsy with concurrent systematic prostate systematic biopsy probably represents the optimal method for the detection of clinically significant prostate cancer.

Reducing the number of systematic biopsy cores in the era of MRI targeted biopsy—implications on clinically-significant prostate cancer detection and relevance to focal therapy planning

“…This study was approved by our Institutional Review Board (2009-1053-D). Our mpMRI protocol and biopsy technique were previously described [8][9][10].…”

MRI-Derived Apparent Diffusion Coefficient of Peri-Prostatic Adipose Tissue Is a Potential Determinant of Prostate Cancer Aggressiveness in Preoperative Setting: A Preliminary Report

“…When the authors focused on PSA density > 0.15ng/mL 2 sub-population, TB had a detection rate of 91%, and only three CS PCa patients were missed if SB was omitted [ 32 ]. Similarly, Lee et al found in the same patients’ category that only 4 (5%) patients with any cancer and 6 (8%) patients with CS PCa would be missed if SB was omitted [ 33 ].…”

Avoiding Unnecessary Systematic Biopsy in Clinically Significant Prostate Cancer: Comparison Between MRI‐Based Radiomics Model and PI‐RADS Category

“…MRI‐based grading (5‐point scoring system), such as the Prostate Imaging Reporting and Data System (PI‐RADS) or Likert scores, plays a major role in stratifying the superiority of targeted biopsy over SB 9,12–15 . Specifically, MRTB has shown to perform better with a greater PI‐RADS score than SB 13,14,16–18 …”

“…10,11 MRI-based grading (5-point scoring system), such as the Prostate Imaging Reporting and Data System (PI-RADS) or Likert scores, plays a major role in stratifying the superiority of targeted biopsy over SB. 9,[12][13][14][15] Specifically, MRTB has shown to perform better with a greater PI-RADS score than SB. 13,14,[16][17][18] Radiomics is a promising approach that facilitates highthroughput extraction of image features from radiographic images to characterize the underlying tumor microarchitecture and heterogeneity, which can be subtle and may not be immediately visible on routine imaging.…”

“…9,[12][13][14][15] Specifically, MRTB has shown to perform better with a greater PI-RADS score than SB. 13,14,[16][17][18] Radiomics is a promising approach that facilitates highthroughput extraction of image features from radiographic images to characterize the underlying tumor microarchitecture and heterogeneity, which can be subtle and may not be immediately visible on routine imaging. 19 It is an important adjuvant tool of PCa detection and risk stratification.…”