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. 2023 Jun;83(9):886-895.
doi: 10.1002/pros.24532. Epub 2023 Apr 4.

Diagnostic performance of microUltrasound at MRI-guided confirmatory biopsy in patients under active surveillance for low-risk prostate cancer

Davide Maffei  1   2 , Vittorio Fasulo  1   2 , Pier Paolo Avolio  1   2 , Cesare Saitta  1   2 , Marco Paciotti  1   2 , Fabio De Carne  1   2 , Piergiuseppe Colombo  1   3 , Luisa Pasini  2 , Silvia Zandegiacomo De Zorzi  2 , Alberto Saita  2 , Rodolfo Hurle  2 , Massimo Lazzeri  2 , Giorgio Ferruccio Guazzoni  1   2 , Paolo Casale  2 , Nicolò Maria Buffi  1   2 , Giovanni Lughezzani  1   2
Affiliations

Diagnostic performance of microUltrasound at MRI-guided confirmatory biopsy in patients under active surveillance for low-risk prostate cancer

Davide Maffei et al. Prostate. 2023 Jun.

Abstract

Background: Active surveillance (AS) represents a standard of care of low-risk prostate cancer (PCa). However, the identification and monitoring of AS candidates remains challenging. Microultrasound (microUS) is a novel high-resolution imaging modality for transrectal ultrasonography (TRUS). We explored the impact of microUS TRUS and targeted biopsies in mpMRI-guided confirmatory biopsies.

Methods: Between October 2017 and September 2021, we prospectively enrolled 100 patients scheduled for MRI-guided confirmatory biopsy at 1 year from diagnosis of ISUP 1 PCa. TRUS was performed using the ExactVu microUS system; PRI-MUS protocol was applied to identify suspicious lesions (i.e., PRIMUS score ≥ 3). All patients received targeted biopsies of any identified microUS and mpMRI lesions and complementary systematic biopsies. The proportion of patients upgraded to clinically significant PCa (defined as ISUP ≥ 2 cancer; csPCa) at confirmatory biopsies was determined, and the diagnostic performance of microUS and mpMRI were compared.

Results: Ninety-two patients had a suspicious MRI lesion classified PI-RADS 3, 4, and 5 in respectively 28, 16, and 18 patients. MicroUS identified 82 patients with suspicious lesions, classified as PRI-MUS 3, 4, and 5 in respectively 20, 50, and 12 patients, while 18 individuals had no lesions. Thirty-four patients were upgraded to ISUP ≥ 2 cancer and excluded from AS. MicroUS and mpMRI showed a sensitivity of 94.1% and 100%, and an NPV of 88.9% and 100%, respectively, in detecting ISUP ≥ 2 patients. A microUS-mandated protocol would have avoided confirmatory biopsies in 18 patients with no PRI-MUS ≥ 3 lesions at the cost of missing four upgraded patients.

Conclusions: MicroUS and mpMRI represent valuable imaging modalities showing high sensitivity and NPV in detecting csPCa, thus allowing their use for event-triggered confirmatory biopsies in AS patients. MicroUS offers an alternative imaging modality to mpMRI for the identification and real-time targeting of suspicious lesions in AS patients.

Keywords: active surveillance; confirmatory biopsy; microUltrasound; multiparametric MRI; prostate cancer.

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References

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