Detection of clinically significant prostate cancer using targeted MRI-informed microultrasound biopsy.

OBJECTIVES: This study compares the rate of detection of clinically significant prostate cancer (csPCa) using multiparametric MRI (mpMRI)-informed microultrasound-guided (microUS) biopsy to historical published data using mpMRI-ultrasound (mpMRI-US) fusion biopsy at the same institution. MATERIALS AND METHODS: A single-center retrospective study of patients who underwent mpMRI-informed microultrasound-guided (microUS) biopsy was performed. Positive predictive value (PPV) of targeted lesions by PI-RADS and PRI-MUS (Prostate Risk Identification Using Microultrasound) was calculated and compared to published data using an mpMRI-US fusion platform. RESULTS: 169 subjects and 244 total lesions were identified by mpMRI. 44/244 (18.0%), 167/244 (68.4%), and 33/244 (13.5%) were PI-RADS 5, 4, and 3, respectively. 206/244 (84.4%) lesions seen on mpMRI were identified on microUS. 26 additional lesions were identified by microUS only. PCa was identified in 120/169 (71.0%) patients, and csPCa was identified in 70/169 (41.4%) by targeted microUS-guided biopsy of MRI lesions. Targeted biopsy of lesions seen only on microUS added three cases of csPCa (73/169, 43.2%). PPV of targeted PI-RADS 5, 4, and 3 lesions for all PCa and csPCa was 0.80, 0.61, and 0.39, and 0.64, 0.31, and 0.12, respectively. Findings were not significantly different compared to historical data using mpMRI-US fusion biopsy (p > 0.05). PPV for csPCa was 0.18 for mpMRI lesions when no correlate was identified by microUS, compared to 0.37 for lesions when a correlate was seen (p < 0.05). CONCLUSIONS: This retrospective study demonstrates successful implementation of microUS-guided biopsy, with similar rates of identification of csPCa compared to historical data using mpMRI-US fusion. KEY POINTS: Question There is limited real-world comparison of the rate of detection of clinically significant prostate cancer using mpMRI-informed microUS-guided biopsy compared to historical mpMRI-ultrasound fusion biopsy. Findings Identification of clinically significant prostate cancer by microUS-guided biopsy was similar to mpMRI-US fusion biopsy, suggesting microUS-guided biopsy performs as well as mpMRI-US fusion biopsy. Clinical relevance Our study shows the complementary role of mpMRI and microUS for the detection of clinically significant prostate cancer, supporting the combined approach of these techniques.

Duke Scholars

Author Rajan Tilak Gupta Radiology, Abdominal Imaging

Author Tara N Morgan Urology

Author Danielle Elizabeth Kruse Radiology, Abdominal Imaging