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Robotic prostate biopsy and its relevance to focal therapy of prostate cancer

Nature Reviews Urology volume 8, pages 579–585 (2011)Cite this article

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Abstract

Focal therapy is an individualized treatment option for prostate cancer, which destroys localized cancerous tissue but not normal tissue, thus avoiding the morbidities associated with whole-gland therapy. Accurate cancer localization and precise ablation are integral to the success of focal therapy, which remains unproven owing to suboptimal patient selection. Currently, there are no clinical or biopsy features that can identify unifocal prostate cancer and no imaging modality that can accurately diagnose or localize prostate cancer. MRI diagnosis has the best accuracy but high cost and limited access hinder its widespread adoption. New management options, including focal therapy and active surveillance, require prostate biopsy to detect, localize and characterize the cancer. Transrectal prostate biopsy has a high false-negative detection rate, which might be related to an inability to biopsy the anterior and apical part of the prostate or interoperator variation. Transrectal biopsy is also associated with sepsis and bleeding. Robotic transperineal prostate biopsy can overcome the limitations of transrectal procedures. Robotic biopsy is automated with high accuracy, has improved access to the apex and anterior part of the prostate and has low risk of sepsis. Furthermore, it involves only two skin punctures, compared with template-based transperineal prostate biopsy, which can result in multiple wounds. Robotic prostate biopsy fulfills the fundamental needs of focal therapy and might be the platform for future treatment delivery for prostate cancer.

Key Points

  • The success of focal therapy for prostate cancer is dependent on the accurate localization of cancer, in order to ensure complete ablation of known disease

  • Transrectal prostate biopsy has a high false-negative detection rate and associated risk of life-threatening infection, which can be overcome with the transperineal approach

  • As new MRI technology is developed, its accuracy for prostate cancer identification is improved

  • An image-guided robotic biopsy system will ensure accurate targeted prostate biopsy and provide a map of prostate cancer location to guide focal therapy delivery

  • Further studies are essential to verify the accuracy of targeted prostate biopsy and the clinical value of robotic and template-based transperineal approaches

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Figure 1: BioXbot—ultrasonography-based robotic prostate biopsy.
Figure 2: Dual-cone concept.
Figure 3: BioXbot software.
Figure 4: Feasibility and safety of the BioXbot.

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Authors and Affiliations

  1. Singapore General Hospital, Urology, Outram Road, 609108, Singapore, Singapore

    Henry Ho, John S. P. Yuen & Christopher W. S. Cheng

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  1. Henry Ho
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H. Ho, J. S. P. Yuen and C. W. S. Cheng contributed equally to the research, discussion of content, writing and reviewing of this manuscript.

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Correspondence to Henry Ho.

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The authors are patent holders/applicants with SingHealth Services Pte Ltd.

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Ho, H., Yuen, J. & Cheng, C. Robotic prostate biopsy and its relevance to focal therapy of prostate cancer. Nat Rev Urol 8, 579–585 (2011). https://doi.org/10.1038/nrurol.2011.131

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