Feasibility of a 2(nd) generation MR-compatible manipulator for transrectal prostate biopsy guidance

OBJECTIVES: To assess the feasibility of a 2(nd) generation MR-compatible, remote-controlled manipulator (RCM) as an aid to perform MR-guided transrectal prostate biopsy in males with suspicion of prostate cancer (PCa). METHODS: This prospective phase I study was approved by the local ethical committee and written informed consent was obtained from each patient. Twenty patients with ≥1 cancer suspicious region (CSR) with a PI-RADS score of ≥3 detected on the diagnostic multi-parametric MRI and no prior prostate treatment underwent MR-guided biopsy with the aid of the RCM. Complications were classified according to the modified Clavien system for reporting surgical complications. For evaluation of the workflow, procedure- and manipulation times were recorded. RESULTS: All CSR’s (n=20) were reachable with the MR-compatible RCM and the cancer detection rate was 70 %. The median procedure time was 36:44 minutes (range, 23 – 61 minutes) and the median manipulation time for needle guide movement was 5:48 minutes (range, 1:15 – 18:35 minutes). Two Clavien grade 1 complications were reported. CONCLUSIONS: It is feasible and safe to perform transrectal MR-guided prostate biopsy using a MR-compatible RCM as an aid. It is a fast and efficient way to biopsy suspicious prostate lesions with a minimum number of biopsies per patient. KEY POINTS: • It is feasible to perform transrectal prostate biopsy using a MR-compatible RCM. • Using a RCM for MR-guided biopsy is safe, fast, and efficient. • All cancer suspicious regions were reachable with the RCM.