Transrectal ultrasound (US) imaging is paramount to the successful completion of prostate biopsies. Certain US features have been associated with prostate cancer (PCa), but their utility remains controversial. We explored the role of multiparametric US (mpUS) in the detection of clinically significant PCa.
We performed a retrospective cohort study to contrast the findings of prostate MRI and mpUS. Patients who underwent MRI, US and biopsy between 2015 and 2021 were included. Biopsies were performed using a systematic approach (12 cores), as well as with MRI (4 cores/lesion) and US (1 core/lesion) targeting. The US features analyzed consisted of: calcifications, hypoechoic lesions and power or color Doppler positivity. Gleason 3 + 4 or higher was used as to define true positives. Measures of diagnostic accuracy were calculated for the different imaging modalities.
The final cohort included 74 patients, of which 24 (32.4%) had clinically significant PCa. The concordance between MRI and US was 63.5%. Seven individuals with discordant results had clinically significant PCa. MRI alone was more sensitive (87.5% vs 75%) but less specific (28% vs 32%) than US alone. An all-inclusive approach considering any suspicious US or MRI finding had a sensitivity of 95.8%. A more restrictive approach, targeting lesions noted in both US and MRI, yielded the highest specificity (50.0%) and accuracy (55.4%).
Biopsy targeting based on US findings can provide additional diagnostic information that may increase sensitivity or specificity. Additional research into this topic could open the door to a more personalized approach to prostate biopsy.
World journal of urology. 2022 Aug 06 [Epub ahead of print]
Nathan Jung, Renzo G DiNatale, Jason Frankel, Hannah Koenig, On Ho, John Paul Flores, Christopher Porter
Urology and Renal Transplantation Service, Department of Surgery, Virginia Mason Medical Center, 1100 Ninth Ave., Seattle, WA, 98101, USA., Urology, SLU Care Urology, 6400 Clayton Rd, Clayton, MO, 63177, USA., Hematology and Oncology Service, Department of Medicine, Virginia Mason Medical Center, 1100 Ninth Ave., Seattle, WA, 98101, USA., Urology and Renal Transplantation Service, Department of Surgery, Virginia Mason Medical Center, 1100 Ninth Ave., Seattle, WA, 98101, USA. .