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The following is a summary of “Clinically significant prostate cancer detection rate in biopsy-naïve patients with mpMRI and micro-ultrasound topographically discordant lesions: A single-center retrospective analysis,” published in the July 2024 issue of Urology by Dagnino et al.

Multiparametric magnetic resonance imaging (mpMRI) has significantly enhanced the detection of clinically significant prostate cancer (csPCa), while micro-ultrasound (micro-US) shows promise in further improving detection rates. This study aimed to compare the efficacy of mpMRI-guided targeted biopsy (MTBx) and micro-US-guided targeted biopsy (micro-US-TBx) in patients with biopsy-naïve with discordant lesions identified by mpMRI and micro-US, and to evaluate the necessity of nontargeted systematic biopsy (SBx). The researchers analyzed data from 178 biopsy-naïve men with suspected prostate cancer and discordant lesions. Each patient underwent both mpMRI and micro-US, with biopsies performed based on the results from both imaging modalities. 

The cohort had a median age of 63 years (IQR, 57–70), a median prostate-specific antigen level of 7 ng/mL (IQR, 5–9 ng/mL), and a median prostate volume of 49 cm³ (IQR, 35–64 cm³). Among these patients, 86 (48%) were diagnosed with prostate cancer, and 51 (29%) had clinically significant prostate cancer.

Micro-US-TBx identified csPCa in 36 of 178 men (20%; 95% CI: 26–46), whereas MTBx identified csPCa in 28 of 178 men (16%; 95% CI: 36–50), resulting in an 8% difference (95% CI: −10 to 4; P = 0.022), reflecting a relative detection rate of 0.043. For clinically insignificant prostate cancer (ciPCa), micro-US-TBx detected 9 of 178 cases (5%; 95% CI: 3–15), compared to 12 of 178 cases (7%; 95% CI: 5–20) detected by MTBx, with a −3% difference (95% CI: −2 to 4; P = 0.2) and a relative detection rate of 0.1. SBx detected ciPCa in 29 men (16%). The combination of mpMRI and micro-US identified csPCa in 51 of 178 patients, with no additional cases detected when SBx was included. Similarly, the combination of MTBx, micro-US-TBx, and SBx identified ciPCa in 35 of 178 men (20%; 95% CI: 18–37), compared to 9 cases (5%) detected using the micro-US pathway alone (P = 0.002) and 14 cases (8%; 95% CI: 6–26) using the mpMRI plus micro-US pathway (P = 0.004).

In conclusion, utilizing a combined approach of micro-US and mpMRI may effectively characterize primary disease in patients with biopsy-naïve discordant lesions and potentially reduce the need for additional SBx. Further research is needed to validate these findings and to better understand the role of micro-US in minimizing unnecessary biopsies.

Source: sciencedirect.com/science/article/abs/pii/S1078143924005350