Diagnostic performance of high-resolution micro-ultrasound and conventional ultrasound in fusion biopsy for clinically significant prostate cancer detection.

Abstract

Background: The aim of this study was to evaluate the diagnostic outcomes of MRI-ultrasound fusion targeted biopsy in detecting clinically significant prostate cancer (csPCa) using either microUS technology or conventional ultrasound.

Methods: We identified a matched sample of 899 patients who underwent biopsy at a single institution between January 2017 and January 2023. A paired group of 470 patients was included. The proportion of cancers detected (any cancer and grade group (GG) ≥ 2) was compared between MRI-microUS and MRI-conventional US fusion biopsy groups.

Results: The overall incidence of GG ≥ 2 cancer was similar between MRI-microUS and MRI-conventional US fusion biopsy groups (53.6% vs. 55.3%, P > 0.05). In patients undergoing MRI-microUS fusion biopsy, detection of any cancer in SB was greater than TB (69.2% vs. 57.1%, P < 0.001), while GG ≥ 2 detection was similar between SB and TB (44.9% vs. 40.5%, P = 0.06). Moreover, detection of any cancer and GG ≥ 2 using TB were lower in the MRI-microUS fusion biopsy group. On multivariable analysis, age, race, biopsy status, PSA density, and PI-RADS score were significantly associated with detection of GG ≥ 2.

Conclusion: MicroUS-guided biopsy and conventional US-guided biopsy had similar rates of overall csPCa detection. Targeted biopsy using MRI-microUS fusion yielded lower overall and csPCa detection compared with MRI-conventional US fusion biopsy. MicroUS fusion biopsy is a reasonable alternative to conventional biopsy to detect csPCa.