Robotic-assisted magnetic resonance imaging ultrasound fusion results in higher significant cancer detection compared to cognitive prostate targeting in biopsy naive men

BACKGROUND: To determine differences in cancer detection rates (CDRs) of regions of interest (ROI) on magnetic resonance imaging (MRI) with robotic-assisted (RA) targeted biopsies (RA-TB) compared to cognitive targeted biopsies (C-TB). METHODS: In a two-centre, retrospective outcome study, a total of 92 consecutive men who had a pre-biopsy MRI, were biopsy naïve and had a transperineal (TP) prostate biopsy between 9/2015 and 7/2017 were included. The primary analysis consists of 39 men who had C-TB and 53 men who had RA-TB. Outcomes from targeted biopsies were reported as CDR for clinically significant prostate cancer (csPC) and for any cancer. RESULTS: Targeted csCDR was higher in RA-TB vs. C-TB (32.1% vs. 10.3%, P=0.014). Targeted CDR of any cancer with Prostate Imaging Reporting and Data System (PI-RADS) 3–5 ROIs was also significantly higher in RA-TB compared to C-TB (47.2% vs. 12.8%, P=0.001). On multivariable analysis significant factors which affected the CDR for csPC was prostate volume only [odds ratio (OR) 1.04, 95% confidence interval (CI): 1.01–1.07]. For any cancer, the CDR was related to prostate volume (OR 1.03, 95% CI: 1.01–1.06) and RA-TB (OR 5.97, 95% CI: 1.69–21.07). RA biopsy results in less acute urinary retention (1.9% vs. 12.8%, P=0.03), less prolonged haematuria (7.5% vs. 38.5%, P<0.01) and shortened biopsy times (24 vs. 32 min, P<0.001). CONCLUSIONS: RA targeted biopsy results in higher CDR for clinically significant cancers and any cancer. It also suffers lower complications compared to cognitive directed TP biopsy. The ease of use and standardisation of the robotic procedure may reduce the learning curve and increase biopsy accuracy.