In-Bore Transrectal MRI-Guided Biopsy With Robotic Assistance in the Diagnosis of Prostate Cancer: An Analysis of 57 Patients

OBJECTIVE. The objective of our study was to analyze the feasibility and potential role of robotic-assisted transrectal MRI-guided biopsy for the diagnosis of prostate cancer. MATERIALS AND METHODS. A total of 57 patients (mean age, 67 +/- 6 [SD] years; age range, 57-83 years; mean prostate-specific antigen level, 10.7 +/- 6.1 ng/mL) with a single prostatic lesion visible on biparametric MRI (T2-weighted and DW images) underwent robotic-assisted MRI-guided transrectal biopsy. The procedure was analyzed in terms of technical success, defined by an accurate alignment of the needle guide with the lesion; occupation time of the MRI room; number of cores; cancer detection rate (CDR); and complications. RESULTS. The biparametric MRI score was 3, 4, and 5 in 11 (19%), 30 (53%), and 16 (28%) of the 57 patients, respectively. Twenty-three lesions (23/57, 40%) originated in the peripheral zone and 34 (34/57, 60%) in the transition zone. Software-based adjustments of the robot allowed the needle guide to be aligned with the target in all lesions. The number of cores was one, two, three, and four in one (2%), 36 (63%), 18 (32%), and three (5%) patients, respectively. Obtaining more than two cores had no incremental value in determining the Gleason score or the maximum cancer core length (MCCL). The overall CDR for any cancer was 67% (38/57). It was 95% (36/38) for tumors with Gleason grade of more than 3 or MCCL greater than 3 mm and 53% (20/38) for tumors with Gleason score greater than 6. No complications were observed. The median occupation time of the MRI room was 37.8 +/- 9.7 minutes (range, 32-74 minutes). CONCLUSION. Robotic-assisted MRI-guided biopsy yields 100% technical success rate with a short MRI room occupation time and high CDRs using one or two cores.