Comparison of micro-ultrasound and multiparametric magnetic resonance imaging for prostate cancer: A multicenter, prospective analysis

  • Laurence Klotz University of Toronto
  • Giovanni Lughezzani Insituto Clinicao Humanitas, Rozzano, Italy
  • Davide Maffei Instituto Clinico Humanitas, Rozzano, Italy
  • Andrea Sanchez Urología Clínica, Clínica IMQ Zorrotzaurre
  • Jose Gregorio Pereira Urología Clínica, Clínica IMQ Zorrotzaurre
  • Frederic Staerman Polyclinique Reims-Bezannes, Bezannes
  • Hannes Cash Charité Universitätsmedizin Berlin
  • Ferdinand Luger Ordensklinikum Linz, Barmherzige Schwestern Linz
  • Laurent Lopez Groupe Urologie Saint-Augustin, Bordeaux
  • Rafael Sanchez-Salas Institut Mutualiste Montsouris, Paris
  • Rob Abouassally Glickman Urological Institute, Cleveland Clinic, Cleveland
  • Neal D. Shore Carolina Urologic Research Center, Myrtle Beach, SC
  • Greg Eure Urology of Virginia, Virginia Beach
Keywords: Prostate cancer, Imaging, High resolution micro ultrasound, MRI, Pi-RADS

Abstract

Introduction: High-resolution micro-ultrasound has the capability of imaging prostate cancer based on detecting alterations in ductal anatomy, analogous to multiparametric magnetic resonance imaging (mpMRI). This technology has the potential advantages of relatively low cost, simplicity, and accessibility compared to mpMRI. This multicenter, prospective registry aims to compare the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of mpMRI with high-resolution micro-ultrasound imaging for the detection of clinically significant prostate cancer.

Methods: We included 1040 subjects at 11 sites in seven countries who had prior mpMRI and underwent ExactVu micro-ultrasound-guided biopsy. Biopsies were taken from both mpMRI targets (PI-RADS >3 and micro-ultrasound targets (PRIMUS >3). Systematic biopsies (up to 14 cores) were also performed. Various strategies were used for mpMRI target sampling, including cognitive fusion with micro-ultrasound, separate software-fusion systems, and software-fusion using the micro-ultrasound FusionVu system. Clinically significant cancer was those with Gleason grade group ≥2.

Results: Overall, 39.5% were positive for clinically significant prostate cancer. Micro-ultrasound and mpMRI sensitivity was 94% vs. 90%, respectively (p=0.03), and NPV was 85% vs. 77%, respectively. Specificities of micro-ultrasound and MRI were both 22%, with similar PPV (44% vs. 43%). This represents the initial experience with the technology at most of the participating sites and, therefore, incorporates a learning curve. Number of cores, diagnostic strategy, blinding to MRI results, and experience varied between sites.

Conclusions: In this initial multicenter registry, micro-ultrasound had comparable or higher sensitivity for clinically significant prostate cancer compared to mpMRI, with similar specificity. Micro-ultrasound is a low-cost, single-session option for prostate screening and targeted biopsy. Further larger-scale studies are required for validation of these findings.

Published
2020-07-17
How to Cite
Klotz, L., Lughezzani, G., Maffei, D., Sanchez, A., Pereira, J. G., Staerman, F., Cash, H., Luger, F., Lopez, L., Sanchez-Salas, R., Abouassally, R., Shore, N. D., & Eure, G. (2020). Comparison of micro-ultrasound and multiparametric magnetic resonance imaging for prostate cancer: A multicenter, prospective analysis. Canadian Urological Association Journal, 15(1). https://doi.org/10.5489/cuaj.6712
Section
Original Research