title: First report of robot-assisted transperineal fusion versus off-target biopsy in patients undergoing repeat prostate biopsy.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Urology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.|Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Kaufmann
authors.affiliation: Department of Urology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Mischinger
authors.affiliation: Department of Urology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Amend
authors.affiliation: Department of Urology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Rausch
authors.affiliation: Department of Urology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Adam
authors.affiliation: Institute of Pathology, Eberhard Karls University, Tuebingen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Scharpf
authors.affiliation: Institute of Pathology, Eberhard Karls University, Tuebingen, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Fend
authors.affiliation: Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Kramer
authors.affiliation: Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Notohamiprodjo
authors.affiliation: Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Nikolaou
authors.affiliation: Department of Urology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Stenzl
authors.affiliation: Department of Urology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany. jens.bedke@med.uni-tuebingen.de.
authors.forename: J
authors.identifier: http://orcid.org/0000-0003-2778-3108
authors.initials: J
authors.lastname: Bedke
authors.affiliation: Department of Urology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Kruck
mesh_terms: D000368:Aged; D006801:Humans; D061705:Image-Guided Biopsy / Q000295:instrumentation / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000473:pathology; D015203:Reproducibility of Results; D012371:Robotics / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000295:instrumentation / Q000379:methods
keywords: 3D imaging; Biopsy; MR-guided interventional procedures; Prostate cancer; Robotics