Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 18.
doi: 10.1002/pros.70036. Online ahead of print.

Prostate Volume and PSA-Density Estimation by Transabdominal Ultrasound: Prospective Evidence of Comparative Accuracy to MRI and Transrectal Ultrasound in Prostate Cancer Early Diagnostics

Liza M Kurucz  1 , Tiziano Natali  2   3 , Sanne Westerhout  4   5 , Marias Hagens  4 , Jeroen J Visser  1 , Erik A M van Muilekom  1 , Jolien D van Kesteren  1 , Ivo Schoots  6 , Thierry N Boellaard  6 , Georgios Agrotis  6 , Behdad Dashtbozorg  1   3 , Theo J M Ruers  1   2   3 , Pim J van Leeuwen  1   4 , Laura S Mertens  1   4
Affiliations

Prostate Volume and PSA-Density Estimation by Transabdominal Ultrasound: Prospective Evidence of Comparative Accuracy to MRI and Transrectal Ultrasound in Prostate Cancer Early Diagnostics

Liza M Kurucz et al. Prostate. .

Abstract

Background: Prostate-specific antigen (PSA) density is an easily available predictor for clinically significant PCa. While transrectal ultrasound (TRUS) is utilized for PSA density (PSAD) estimation, transabdominal ultrasound (TAUS) is a more accessible, noninvasive alternative that can be used to decide if follow-up diagnostics are necessary. This study aims to compare prostate volume (PV) and PSAD across TAUS, TRUS and MRI, comparing the clinical utility of TAUS and TRUS for PSAD-based risk stratification.

Methods: Hundred and eighty men undergoing PCa diagnostics were included by collecting serum PSA, TRUS, MRI, and TAUS PV examinations. PV was calculated blindly by all operators and image quality was assessed. Agreement in PV measurements of all imaging modalities was analyzed in Bland-Altman diagrams. PCa risk derived from PSADTAUS and PSADTRUS was compared against MRI outcomes in Sankey diagrams and the percentage of misclassified PCa risk was reported.

Results: After excluding 33 inadequate TAUS acquisitions, 147 patients were included. The average volume difference between TAUS and MRI was 2.5 mL (standard deviation (SD): 16.4), between TAUS and TRUS 11.5 mL (SD: 20.4), and between TRUS and MRI -9.0 mL (SD: 21.1). TAUS and TRUS underestimate PCa risk in 3%-4%, while the percentage of men with overestimated risk decreased when TAUS was used (7% vs. 13%).

Conclusions: PVs obtained with TAUS are equivalent to MRI. Still, image quality varies with experience and interobserver variability needs further exploration, ensuring generalizable outcomes. Nevertheless, TAUS represents a valid alternative for PV and PSAD estimation, enabling a patient-friendly alternative for PCa risk assessment.

Keywords: magnetic resonance imaging; prostate cancer risk‐stratification; prostate volume; transabdominal ultrasound; transrectal ultrasound.

PubMed Disclaimer

References

    1. O. Bratt, A. Auvinen, R. Arnsrud Godtman, et al., “Screening for Prostate Cancer: Evidence, Ongoing Trials, Policies and Knowledge Gaps,” BMJ Oncology 2, no. 1 (April 2023): e000039.
    1. H. Van Poppel, R. Hogenhout, P. Albers, R. C. N. van den Bergh, J. O. Barentsz, and M. J. Roobol, “A European Model for an Organised Risk‐Stratified Early Detection Programme for Prostate Cancer,” European Urology Oncology 4, no. 5 (October 2021): 731–739.
    1. M. J. Roobol, E. W. Steyerberg, R. Kranse, et al., “A Risk‐Based Strategy Improves Prostate‐Specific Antigen–Driven Detection of Prostate Cancer,” European Urology 57, no. 1 (January 2010): 79–85.
    1. P. J. van Leeuwen, A. Hayen, J. E. Thompson, et al., “A Multiparametric Magnetic Resonance Imaging‐Based Risk Model to Determine the Risk of Significant Prostate Cancer Prior to Biopsy,” BJU International 120, no. 6 (2017): 774–781.
    1. I. Yusim, M. Krenawi, E. Mazor, V. Novack, and N. J. Mabjeesh, “The Use of Prostate Specific Antigen Density to Predict Clinically Significant Prostate Cancer,” Scientific Reports 10, no. 1 (November 2020): 20015.

LinkOut - more resources