V6-14: Robotic Transperineal Prostate Saturation Biopsy: Technique and Outcomes

Video

Introductions and Objectives
Prostate biopsy is central to prostate cancer diagnosis and prognosis. The transperineal approach allows adequate anterior zone sampling and reduces the risk of sepsis. We demonstrate, in this video, our technique of robotic-assisted transperineal saturation prostate biopsy (rTPB).

Methods
rTPB was performed in 249 patients from 2007 to 2012 via 2 transperineal punctures using our novel prostate biopsy device (Biobot Surgical, Singapore). The indications for biopsy were rising PSA despite prior negative transrectal biopsy in 199 patients, staging biopsy in 40 patients with low- intermediate risk prostate cancer, and active surveillance biopsy in 10 patients.

Results
Mean time taken for the procedure was 16.4 minutes (±8.0). Mean prostate volume was 31.2 ml (±14.0). Mean number of cores obtained was 29.4 (±5.4, range 15 – 53), with a total of 7251 cores obtained. Repeat biopsy was performed for 71 cores in 36 patients for cores having no tissue, being too short and/or being fragmented. Prostate cancer was detected in 485 cores in 112 patients, with 68 having a Gleason ≤ 6, 28 Gleason 3+4, 12 Gleason 4+3 and 4 Gleason 8. The mean number of cores positive for those diagnosed with cancer was 4.3 (±3.6) and the median percentage core involvement was 15% (IQR 0.7 – 50). The rate of haematuria was 2.8%, sepsis 0.8% and urinary tract infection 0%. Twenty percent of patients with prostate volume larger than 50 ml had urinary retention requiring a urinary catheter for 2 – 7 days.

Conclusions
rTPB is a feasible procedure for prostate cancer diagnosis and prognosis with a low rate of complications.

Funding: none