Department of Urology, Charité-University Medicine Berlin, Berlin, Germany.
Department of Radiology, Charité-University Medicine Berlin, Berlin, Germany.
Eur Urol Focus. 2021 Nov;7(6):1292-1299. doi: 10.1016/j.euf.2020.06.022. Epub 2020 Jul 9.
Although multiparametric magnetic resonance imaging (mpMRI) revolutionized the implementation of prostate biopsies, a considerable amount of clinically significant prostate cancer (csPCa) is missed when performing mpMRI-targeted biopsies only. Microultrasound (micro-US) is a new modality that allows real-time targeting of suspicious regions.
To evaluate micro-US of the prostate with real-time targeting of suspicious regions in patients suspected to have prostate cancer (PCa).
DESIGN, SETTING, AND PARTICIPANTS: We examined 159 patients with prior mpMRI and suspicion of PCa with micro-US in the period from February to December 2018. Micro-US lesions were documented according to the prostate risk identification for micro-US (PRI-MUS) protocol, and were blinded to the mpMRI results and targeted independently of the mpMRI lesions.
The main outcomes were cancer detection rate, additional detection of csPCa, and International Society of Urological Pathology (ISUP) grade group upgrading via micro-US.
PCa was found in 113/159 (71%) men, with 49% (78/159) having clinically significant cancer (csPCa; ISUP ≥ 2). Micro-US-targeted biopsies resulted in a higher ISUP grade group than the nontargeted biopsies in 26% (42/159), compared with both nontargeted and MRI-targeted biopsies in 16% (26/159). In 17% (27/159) of patients, targeted mpMRI-guided biopsy was negative with cancer identified in the micro-US-guided biopsy, of whom 20 had csPCa. The comparison with only MRI-positive patients is the main limitation of this analysis.
Our data show an added benefit of micro-US in addition to mpMRI-targeted biopsies in a population of men at risk of PCa. A novel biopsy protocol with solely targeted biopsy with micro-US and mpMRI seems possible, replacing conventional ultrasound and omitting standard systematic biopsies.
In this report, we looked at the performance of microultrasound in the setting of diagnosing prostate cancer. We found that microultrasound is a good addition to magnetic resonance imaging (MRI) of the prostate and presents an alternative for men who may not undergo MRI.
尽管多参数磁共振成像（mpMRI）彻底改变了前列腺活检的实施方式，但仅进行 mpMRI 靶向活检会遗漏相当一部分有临床意义的前列腺癌（csPCa）。微超声（micro-US）是一种新的模式，可以实时靶向可疑区域。
评估在疑似前列腺癌（PCa）患者中，使用实时靶向可疑区域的前列腺 micro-US。
设计、设置和参与者：我们检查了 159 名在 2018 年 2 月至 12 月期间进行过 mpMRI 检查且疑似 PCa 的患者，他们接受了 micro-US 检查。根据前列腺风险识别微超声（PRI-MUS）方案记录 micro-US 病变，并对 mpMRI 结果和靶向结果均设盲，独立于 mpMRI 病变进行靶向。
主要结果是癌症检出率、通过 micro-US 检测到的 csPCa 额外检出率以及国际泌尿病理学会（ISUP）分级分组升级率。
159 名男性中有 113 名（71%）发现了前列腺癌，其中 49%（78/159）有临床显著的癌症（csPCa；ISUP≥2）。与非靶向活检相比，micro-US 靶向活检导致 ISUP 分级分组升高的比例为 26%（42/159），与非靶向和 MRI 靶向活检相比为 16%（26/159）。在 17%（27/159）的患者中，靶向 mpMRI 引导活检呈阴性，而在 micro-US 引导活检中发现了癌症，其中 20 例有 csPCa。本分析的主要局限性是仅与 MRI 阳性患者进行比较。
我们的数据表明，在有前列腺癌风险的男性人群中，除了 mpMRI 靶向活检外，micro-US 还有额外的益处。一种新的活检方案，仅用 micro-US 和 mpMRI 进行靶向活检，似乎是可能的，可以替代传统超声，并省略标准系统活检。
在本报告中，我们研究了微超声在诊断前列腺癌中的表现。我们发现，微超声是 MRI 前列腺成像的很好补充，为可能不接受 MRI 检查的男性提供了一种替代方法。
