Targeted vs systematic robot‐assisted transperineal magnetic resonance imaging‐transrectal ultrasonography fusion prostate biopsy

Objective To evaluate the performance of transperineal robot‐assisted (RA) targeted (TB) and systematic (SB) prostate biopsy in primary and repeat biopsy settings. Patients and Methods Patients underwent RA biopsy between 2014 and 2016. Before RA‐TB, multiparametric magnetic resonance imaging (mpMRI) was performed. Prostate lesions were scored (Prostate Imaging, Reporting and Data System, version 2) and used for RA‐TB planning. In addition, RA‐SB was performed. Available, whole‐gland pathology was analysed. Results In all, 130 patients were biopsy naive and 72 had had a previous negative transrectal ultrasonography‐guided biopsy. In total, 202 patients had suspicious mpMRI lesions. Clinically significant prostate cancer was found in 85% of all prostate cancer cases (n = 123). Total and clinically significant prostate cancer detection rates for RA‐TB vs RA‐SB were not significantly different at 77% vs 84% and 80% vs 82%, respectively. RA‐TB demonstrated a better sampling performance compared to RA‐SB (26.4% vs 13.9%; P < 0.001). Conclusion Transperineal RA‐TB and ‐SB showed similar clinically significant prostate cancer detection rates in primary and repeat biopsy settings. However, RA‐TB offered a 50% reduction in biopsy cores. Omitting RA‐SB is associated with a significant risk of missing clinically significant prostate cancer.