MP55-15 IS MICROULTRASOUND A RELIABLE TOOL FOR PROSTATE CANCER DIAGNOSIS? RESULTS FROM A SINGLE-INSTITUTION COHORT OF OVER 1,000 MEN
Abstract
INTRODUCTION AND OBJECTIVE:
Microultrasound (mUS) is a new imaging modality that has been proposed as a possible alternative to mpMRI for the diagnosis of Prostate Cancer (PCa). We evaluated the diagnostic performance in the detection of PCa and mUS specific predictors of PCa.
METHODS:
Between September 2017 and November 2021, data from 1,004 consecutive men who underwent mUS at our tertiary center were prospectively collected. Prior to prostate biopsy, all patients performed a mUS evaluation and those with lesions suspicious for PCa underwent transrectal cognitive targeted biopsies (TBx). PRI-MUS grading system was used to assess the risk of PCa, and any lesion with a PRI-MUS ≥ 3 was considered suspicious. All mUS assessment were performed by 2 urologists with years of experience in US. Primary endpoint was to assess the diagnostic performance of mUS in PCa and csPCa detection. The secondary endpoint was to assess the mUS-derived characteristics associated with PCa and csPCa diagnosis.
RESULTS:
Median age was 66 years (IQR:60-72); median PSA was 7 (IQR:5-10); 283 (28%) had a positive DRE; median prostate volume was 50 cc (IQR:35-70); 257 (25.6%) had familiarity for PCa; 392 (30%) had previous prostate biopsies; 766 (76.3%) patients had positive mUS; 193 (19.2%) had>1 mUS lesion; out of 766 positive mUS, 10.5% were PRI-MUS 3, 45.2% PRI-MUS 4, and 20.5% PRI-MUS 5. MicroUS detected suspicious lesions in 448/527 (85%) PCa patients and in 325/366 (88.8%) csPCa patients. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the detection of PCa were 85%, 32.3%, 58.6% and 65.7%, respectively; and 88.8%, 23.1%, 73.7% and 46% for csPCa. Out of 448 positive mUS, 172 (38.4%) PCa cases were diagnosed with mUS TBx, of which 147 were csPCa. At multivariable regression model with PCa diagnosis as outcome, having a positive mUS was significantly associated with PCa diagnosis (OR:2.01, 95%CIs:1.28-3.16). In the model with csPCa as main outcome, positive mUS was no longer a significant predictor (OR:1.84, 95%CIs:0.83-4.12). PRIMUS 5 lesion was the only mUS factor associated with PCa diagnosis (OR:2.69, 95%CIs:1.05-6.9). Furthermore, we found a significant increase in the trend of PCa detection at mUS by both operators comparing the first quarter (12,5 months) of the study period and the last 3 quarters (ptrend=0.02 for operator 1; ptrend=0.01 for operator 2).
CONCLUSIONS:
Our results confirmed the role of mUS in the diagnostic pathway of PCa. Further randomized studies are needed to confirm the potential role of mUS in the diagnostic pathway of PCa.
Source of Funding:
None.