EAU 2019: Diagnostic Accuracy of Targeted Prostate Biopsies: Results from a Prospective Trial Comparing Micro-Ultrasound with Multiparametric MRI for the Detection of Prostate Cancer

Barcelona, Spain (UroToday.com) Targeted multi-parametric MRI (mpMRI) fusion biopsies are replacing systematic US-guided biopsies as the standard of care. High-resolution micro-ultrasound (micro-US) is a new real-time US-based imaging modality enabling real-time targeted prostate biopsies.

In this study – the authors examined the efficacy of a micro-US as a new diagnostic approach to targeted biopsies.  Moreover, the authors compared the diagnostic accuracy of micro-US with mpMRI in a prospectively collected cohort of patients with suspected prostate cancer.

The study population consisted of 179 consecutive patients with at least one suspicious lesion (PIRADSv2≥3) according to mpMRI. All patients were enrolled within a prospective trial aimed at comparing the diagnostic accuracy of micro-US and mpMRI. The PRI-MUS risk identification protocol was used to identify targets on micro-US. The urologist, newly trained on performing the micro-US targeted-biopsies, was blinded to the mpMRI results until after the micro-US targeting was complete. All patients received targeted biopsy (based on micro-US and mpMRI imaging) and systematic random biopsies. The concordance between mpMRI and micro-US findings and biopsy results were determined. Figure 1 demonstrates the trial design.

Figure 1 – Trial design:


The diagnosis of any prostate cancer and clinically significant prostate cancer (Gleason score >=7) was assessed. The concordance between mpMRI and micro-US and the biopsy results was determined.

The results demonstrated that the prostate cancer detection rate was 56.5%, and the clinically significant prostate cancer detection rate was 38%. As the PRI-MUS score and PIRADS score increased, so did the proportion of patients with clinically significant prostate cancer. A total of 111 concordant target zones between micro-US and mpMRI were identified, of which 50 were clinically significant cancer. Figure 2 demonstrates a summary of the results.

Figure 2 – Study results:

EAU 2019 fig 2 study results

In conclusion, micro-US is a promising new imaging modality for targeted prostate biopsies, enabling high sensitivity of 91.2% in prostate cancer detection. Further studies are warranted to investigate how the new micro-US modality can best be leveraged within the prostate cancer diagnostic pathway.

Presented by: Davide Maffei, MD, Humanitas Clinical and Research Center, Department of Urology, Rozzano, Italy

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 34th European Association of Urology (EAU 2019) #EAU19, conference in Barcelona, Spain from March 15-19, 2019.

Newsletter subscription

Free Daily and Weekly newsletters offered by content of interest

The fields of GU Oncology and Urology are rapidly advancing. Sign up today for articles, videos, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.