The combined value of mpUS and mpMRI-TRUS fusion for the diagnosis of clinically significant prostate cancer

Abstract

Objective: To evaluate the combined efficacy of multiparametric ultrasonography (mpUS) and multiparametric magnetic resonance imaging/transrectal ultrasound (mpMRI-TRUS) fusion for detecting clinically significant prostate cancer (csPCa).

Methods: From November 2019 to September 2021, biopsy-naïve patients underwent mpMRI-TRUS fusion imaging combined with mpUS-guided targeted biopsies (TB) and systematic biopsies (SB). To further evaluate the additional diagnostic value of mpUS, the imaging features of 202 focus obtained from fusion imaging were assessed. The diagnostic accuracies of mpMRI-TRUS fusion imaging and the combination of mpMRI-TRUS fusion imaging with mpUS for csPCa were comparatively evaluated.

Results: A total of 202 prostate lesions (160 patients) were included in the final analysis, of which 105 were csPCa, 16 were ciPCa, and 81 were noncancerous. The median patient age was 69 (65-73) years and the median tPSA was 22.07 (11.22-62.80) ng/mL. For csPCa, the detection rate of TB was higher than that of SB (50.0% vs. 45.5%, p < 0.05). The imaging characteristics of mpUS in the PCa and non-PCa groups were significantly different (p < 0.001). When compared with mpMRI-TRUS fusion imaging, the positive predictive value, false positive rate, and area under the curve (AUC) of csPCa diagnosis by mpMRI-TRUS fusion imaging combined with mpUS increased by 11.30%, decreased by 19.58%, and increased from 0.719 to 0.770 (p < 0.05), respectively.

Conclusion: TB can improve the detection rate of csPCa and hence can be effectively used in the diagnosis and risk assessment of csPCa. The mpUS-enriched valuable diagnostic information for mpMRI-TRUS fusion imaging and their combination showed a higher diagnostic value for csPCa, which can guide subsequent clinical treatment.

Keywords: Contrast-enhanced ultrasonography; Elastography; Multiparametric ultrasound; Prostate cancer; Real-time mpMRI; TRUS fusion biopsy.

Fig. 1

The patient is 69 years old, with TPSA: 560 ng/mL. MpMRI showed suspicious signals in the left central gland and the peripheral zone, mpMRI ( +). Pathological results showing that the lesions were carcinomas, with a Gleason score of 4 + 5 = 9. (A) MpMRI-TRUS fusion, showing the left central and peripheral gland hypoechoic area, with an aspect ratio ≥ 1 and the sign of capsule bulge. (B) CEUS in the targeted area showing fast-forward enhancement (18 s) and hyperperfusion. (C) TRES of the targeted area showing asymmetric, focal non-strain (blue areas entirely covering the entire lesion and beyond the lesion). (D, E) Punctures of the targeted area

Fig. 2

The patient is 78 years old, with TPSA: 62.43 ng/mL. MpMRI showing suspicious signals in the 6–8 O'clock direction of the right peripheral zone (blue arrow), mpMRI ( +). MpMRI showing a nodule in the 5 O'clock direction of the left peripheral zone (white arrow), mpMRI (-). Pathological results implying that the lesions in the right and left peripheral zones are carcinomas, with a Gleason score of 3 + 4 = 7 and 4 + 3 = 7, respectively. (A) MpMRI-TRUS fusion showing the bilateral peripheral gland hypoechoic area, with the sign of capsule bulge in the left peripheral zone. (B) CEUS in the targeted area showing fast-forward and backward enhancements (13 s) as well as hyperperfusion in the right peripheral zone. CEUS in the targeted area showing nonperfusion in the left peripheral zone. (C) TRES of the targeted area showing asymmetric, focal non-strain (the area in the middle of the lesion is blue and the surrounding tissue is green). (D, E) Punctures of the targeted area

Fig. 3

The ROC curves of different imaging modalities in the diagnosis of csPCa