Robotic-Assisted Perineal Fusion Prostate Biopsy: Technique, Advantages, and Clinical Considerations

Year 2025, Volume: 1 Issue: 1, 25 - 28, 30.09.2025

Ali Haydar Yılmaz , Barbaros Başeskioğlu

Abstract

Introduction: Prostate cancer is the second most common cancer worldwide and the fifth leading cause of cancer-related mortality in men. A prostate biopsy not only provides a diagnosis but also gives an idea about the characterization of the tumor, its pathological staging, and its localization on the prostate. Accurate diagnosis, staging, and localization are essential for optimal treatment planning. Multiparametric MRI (mpMRI) prior to biopsy improves the detection of clinically significant prostate cancer by increasing both sensitivity and specificity. The biopsy is performed rectally or using a perineal technique. When taken transrectal route, there is a risk of rectal bleeding and life-threatening sepsis. Methods: Asymptomatic patients with a life expectancy of ≥10–15 years, abnormal PSA levels, abnormal digital rectal examination, or positive family history underwent mpMRI screening.Lesions classified as PI-RADS 3–5 are targeted for biopsy using MRI–ultrasound fusion guidance. The procedure is performed under general, spinal, regional, or local anesthesia, with prophylactic antibiotics administered 60 minutes prior. Robotic perineal biopsy enables precise needle placement, with only two perineal insertions regardless of the number of samples obtained. Results: Robotic perineal biopsy reduces false-negative rates and facilitates sampling from anterior and apical prostate regions, which are challenging in conventional transrectal biopsies. Compared to transrectal approaches, the perineal route significantly lowers the risk of post-biopsy sepsis. Unlike classical brachytherapy template-based biopsies requiring multiple punctures, the robotic method minimizes tissue trauma, pain, and complication risk, thereby preserving patient quality of life. Conclusion: Robotic perineal MRI–ultrasound fusion biopsy is a safe, accurate, and patient-friendly technique that offers superior lesion targeting, reduced infection risk, and fewer complications compared to conventional methods. It represents an effective approach for the diagnosis and characterization of clinically significant prostate cancer.

Keywords

biopsy , prostate , fusion , robotic

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