To compare software-based three-dimensional-guided systematic prostate biopsy (3D-GSB) with conventional transrectal ultrasound (TRUS)-guided systematic biopsy (TGSB) regarding prostate cancer (PCa) detection rates (CDR).
In total, 956 patients (200 TGSB patients and 756 3D-GSB patients) without prior positive biopsies and with a prostate specific antigen (PSA)-value ≤ 20 ng/ml were eligible for analysis. TGSB and 3D-GSB cases were matched in a 1:1 ratio using propensity score-matching with age, PSA, prostate volume, previous biopsy status and suspicious palpatory finding as confounders. 3D-GSB was conducted with the semi-robotic prostate fusion biopsy system ArtemisTM. For each patient in both groups, SB was conducted in a similar pattern with 12 cores. All cores in 3D-GSB were automatically planned and mapped on a 3D-model as well as on the real-time TRUS imaging. Primary end points were the clinically significant (cs) and overall CDR. Secondary end point was the cancer-positive core rate.
After matching, the csCDR was not significantly different between the 3D-GSB and the TGSB groups (33.3% vs. 28.8%, p=0.385). Overall CDR was significantly higher for 3D-GSB compared to TGSB (55.6% vs. 39.9%, p=0.002). 3D-GSB detected significantly more non-significant PCa than TGSB (22.2% vs. 11.1%, p=0.004). In patients with PCa, the number of cancer-positive SB cores was significantly higher by TGSB (42% vs. 25%, p <0.001).
3D-GSB was associated with a higher CDR than TGSB. However, no significant difference was shown in detection of csPCa between both techniques. Therefore, currently 3D-GSB does not appear to add value to conventional TGSB.
Urology. 2023 Apr 03 [Epub ahead of print]
Fabian Derigs, Karl-Friedrich Kowalewski, Friedrich Otto Hartung, Frank Waldbillig, Manuel Neuberger, Jost von Hardenberg, Niklas Westhoff
Department of Urology and Urologic Surgery, University Medical Centre, University Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. Electronic address: ., Department of Urology and Urologic Surgery, University Medical Centre, University Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. Electronic address: ., Department of Urology and Urologic Surgery, University Medical Centre, University Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. Electronic address: ., Department of Urology and Urologic Surgery, University Medical Centre, University Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. Electronic address: ., Department of Urology and Urologic Surgery, University Medical Centre, University Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. Electronic address: ., Department of Urology and Urologic Surgery, University Medical Centre, University Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. Electronic address: ., Department of Urology and Urologic Surgery, University Medical Centre, University Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. Electronic address: .