MRI vs Transrectal Ultrasound to Estimate Prostate Volume and PSAD: Impact on Prostate Cancer Detection.

To compare multiparametric magnetic resonance imaging (mpMRI) and transrectal ultrasound (TRUS) to estimate prostate volume and prostate specific antigen density (PSAD) as well as subsequent impact on prostate cancer (PCa) detection.

Patients referred for mpMRI prior to mpMRI-TRUS fusion-guided prostate biopsy between 2015 and 2020 were identified. Volume and calculated PSAD by mpMRI and TRUS were compared. Associations with presence of any PCa and clinically significant PCa (csPCa; Gleason ≥3+4) were evaluated using linear regression (interaction by volume quartile), logistic regression, and receiver operating characteristics.

Among 640 men, TRUS underestimated prostate volume relative to mpMRI (median 49.2cc vs. 54.1cc) with 8% lower volume per cc up to 77.5cc (1st-3rd quartile) and 39% lower volume per additional cc above 77.5cc (4th quartile). For men undergoing radical prostatectomy, mpMRI had a higher correlation coefficient relative to TRUS (0.913 vs. 0.878) when compared to surgical pathology. mpMRI PSAD had slightly higher odds vs. TRUS PSAD for detecting any PCa (OR 2.94 and OR 2.78, both p<0.001) or csPCa (OR 4.20 and OR 4.02, both p<0.001). AUC improvements were of borderline significance for mpMRI vs. TRUS PSAD for any PCa (0.689 vs. 0.675, p=0.05) and not significant for csPCa (0.732 vs. 0.722, p=0.20). PSAD was not associated with PCa detection for prostates ≥77.5cc.

TRUS underestimates prostate volume relative to mpMRI. PSAD based on mpMRI may be better associated with detection of PCa compared to TRUS, but utility of PSAD may be limited for larger prostates.

Urology. 2022 Sep 21 [Epub ahead of print]

Shawn Choe, Hiten D Patel, Nicholas Lanzotti, Yudai Okabe, Goran Rac, Steven M Shea, Alex Gorbonos, Marcus L Quek, Robert C Flanigan, Ari Goldberg, Gopal N Gupta

Department of Urology, Loyola University Medical Center, Maywood, IL. Electronic address: ., Department of Urology, Loyola University Medical Center, Maywood, IL; Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL. Electronic address: ., Department of Urology, Loyola University Medical Center, Maywood, IL. Electronic address: ., Department of Urology, Loyola University Medical Center, Maywood, IL. Electronic address: ., Department of Urology, Loyola University Medical Center, Maywood, IL. Electronic address: ., Department of Radiology, Loyola University Medical Center, Maywood, IL. Electronic address: ., Department of Urology, Loyola University Medical Center, Maywood, IL. Electronic address: ., Department of Urology, Loyola University Medical Center, Maywood, IL. Electronic address: ., Department of Urology, Loyola University Medical Center, Maywood, IL. Electronic address: ., Department of Radiology, Loyola University Medical Center, Maywood, IL. Electronic address: ., Department of Urology, Loyola University Medical Center, Maywood, IL; Department of Radiology, Loyola University Medical Center, Maywood, IL. Electronic address: .

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