Sperling Prostate Center

Would You Trust Your Prostate to a Robot?

If you want your home to outsmart your neighbor’s, you can count on robotics to make you the leader on the block. Today’s smart home is equipped with robots that are trusted to mop floors, wash windows, tutor your tots, and even become your canine best friend! [Note: links to products are intended only as examples and do not in any way endorse specific items.]

No longer the science fiction dream of humanity’s electronic servants, robots are a fact of life. They are increasingly commonplace in areas like industry, transportation, the military, and even healthcare. One aspect of men’s healthcare is diagnosing prostate cancer (PCa). So far, the only way to obtain a definitive biopsy is through analysis of prostate tissue—and the only way to obtain prostate tissue is extracting it using hollow needles. This is called a needle biopsy.

Conventional biopsies are performed manually by a urologist or other specialist. There are two access routes: transrectal (through the rectal wall) and transperineal (through the perineum or skin between the scrotum and the anus. Most biopsies are performed in a urologist’s practice via the transrectal route, with needle placement guided by transrectal ultrasound (TRUS). However, a published paper by Zhang et al. (2023) point outs out that TRUS guided biopsies are plagued with inaccuracy (overdetection of insignificant PCa, underdetection of significant PCa):

TRUS image resolution is low and the biopsy process is blindly operated by urologists which completely depends on their experience and skills. Manual operation sometimes shows uncertainty. Errors in centimeters are common in clinical practice. Other than that, it is limited by the low sensitivity of 60% cancer detection. As a result, the diagnostic rate of patients with PSA values of 4–10 ng/ml was only 20%–30%.[i]

MRI improves biopsy accuracy

Thanks to multiparametric MRI, identifying and targeting suspicious lesions has become more accurate due to high resolution anatomic definition and tissue characterization. TRUS cannot differentiate between normal and cancerous areas, whereas MRI can. MRI enables planning where to place biopsy needles, and guides insertion into the suspicious area(s) most likely to harbor aggressive cancer cells. However, even though real-time MRI targeted biopsy performed in the bore (tunnel) of the magnet typically needs only a minimum number of precisely targeted needles, precision MRI-targeted biopsy can be more time-consuming than a random systematic 12-14 needles TRUS biopsy.

Robotic biopsy, an accurate timesaver

Robotic-assisted biopsy systems are constructed of magnet-compatible equipment with compact design so it can be used within the bore. Just as a practical homeowner may turn over domestic tasks to more efficient and accurate robots, the Sperling Prostate Center and many other MRI facilities around the world have already begun to employ robotic equipment. Given numerous robotic systems, the authors describe the general steps of a robotic biopsy once the patient has been numbed to avoid pain:

First, the patient is placed on the MRI scanner table, an initial MRI scan is performed on the patient to locate suspicious tissue and the [doctor] makes a biopsy plan based on the MRI images and cleans and disinfects the biopsy equipment. To realize the automatic biopsy of the robot, it is necessary to register the robot coordinate system with the MRI image coordinate system so that the two can be unified into the same coordinate space. Then, the doctor selects a biopsy position and the robot automatically sets the insertion direction and depth of the biopsy needle according to the biopsy position and automatically places the biopsy needle through the coordinated movement of the joints. After the setting is completed, the robot triggers the biopsy device to obtain the patient’s pathological tissue. At the same time, the patient is scanned by MRI to determine whether the needle reaches the target point. If it fails, the process is repeated. After completing the above steps, the robot repositions to the next biopsy position and repeats the above process for subsequent biopsies under the supervision of doctors.

Most of the current robotic systems have been designed for in-bore biopsies, and published studies are revealing their benefits. While a few more systems are being developed for use with TRUS or MRI/TRUS fusion guidance, the authors write, “The accuracy of fusion is limited due to the difference in the position and shape of the prostate between the MRI image acquired before surgery and the image obtained by the intraoperative TRUS probe. Thus, fusion accuracy is the main problem in MRI-TRUS fusion image guided prostate biopsy robotic systems.” Thus, research supports real-time MRI guidance as the most accurate diagnostic method with the fewest needles. The authors also the integration of Artificial Intelligence in the “learning and independent decision-making capabilities of prostate biopsy robots.”

We are proud to already be on board with the wave of the future as a smart Center. Our patients know they can trust us with their prostate-related needs. As we envision the accelerating pace of robotics and Artificial Intelligence in our MRI-based PCa detection, diagnosis and treatment services, all of us enthusiastically declare, “Bring it on!”

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

[i] Zhang Y, Yuan Q, Muzzammil HM, Gao G, Xu Y. Image-guided prostate biopsy robots: A review. Math Biosci Eng. 2023 Jul 17;20(8):15135-15166.

About Dr. Dan Sperling

Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.

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