Multiparametric MRI‐Ultrasound Software Fusion Prostate Biopsy – Initial Results Using A Stereotactic Robotic Assisted Transperineal Prostate Biopsy Platform Comparing Systematic Versus Targeted Biopsy

OBJECTIVES: To compare the detection rates of prostate cancer between systematic biopsy and targeted biopsy using a stereotactic robot-assisted transperineal prostate platform. MATERIALS AND METHODS: We identified consecutive men with suspicious lesion(s) on multi-parametric magnetic resonance imaging (mpMRI) who underwent both systematic and MRI-transrectal ultrasound (US) fusion targeted biopsy using our proprietary transperineal robot-assisted prostate biopsy platform between January 2015 to January 2019 at our institution for retrospectively analysis. Comparative analysis between systematic and targeted biopsy using McNemar's test and further stratified by prior biopsy status and PI-RADS v2.0 score. ISUP grade group ≥2 cancers (previously known as gleason grade ≥7) were considered to be clinically-significant. RESULTS: Five hundred patients were included in our final analysis, out of which 67 (13%) were low-risk cancer patients on AS. Of the 433 men without prior diagnosis of cancer, 288 (67%) were biopsy naive. 248 (57%) were diagnosed with prostate cancer, with 199 (46%) having clinically-significant prostate cancer (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). Out 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. Out 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 likely represents the optimal method for the detection of clinically-significant prostate cancer.