Diagnostic performance of microUltrasound at MRI-guided confirmatory biopsy in patients under active surveillance for low-risk prostate cancer.

Autor: Maffei D; Department of Biomedical Sciences, Humanitas University, Milan, Italy.; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy., Fasulo V; Department of Biomedical Sciences, Humanitas University, Milan, Italy.; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy., Avolio PP; Department of Biomedical Sciences, Humanitas University, Milan, Italy.; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy., Saitta C; Department of Biomedical Sciences, Humanitas University, Milan, Italy.; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy., Paciotti M; Department of Biomedical Sciences, Humanitas University, Milan, Italy.; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy., De Carne F; Department of Biomedical Sciences, Humanitas University, Milan, Italy.; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy., Colombo P; Department of Biomedical Sciences, Humanitas University, Milan, Italy.; Department of Pathology, IRCCS Humanitas Research Hospital, Milan, Italy., Pasini L; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy., De Zorzi SZ; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy., Saita A; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy., Hurle R; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy., Lazzeri M; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy., Guazzoni GF; Department of Biomedical Sciences, Humanitas University, Milan, Italy.; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy., Casale P; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy., Buffi NM; Department of Biomedical Sciences, Humanitas University, Milan, Italy.; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy., Lughezzani G; Department of Biomedical Sciences, Humanitas University, Milan, Italy.; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy.
Jazyk: angličtina
Zdroj: The Prostate [Prostate] 2023 Jun; Vol. 83 (9), pp. 886-895. Date of Electronic Publication: 2023 Apr 04.
DOI: 10.1002/pros.24532
Abstrakt: Background: Active surveillance (AS) represents a standard of care of low-risk prostate cancer (PCa). However, the identification and monitoring of AS candidates remains challenging. Microultrasound (microUS) is a novel high-resolution imaging modality for transrectal ultrasonography (TRUS). We explored the impact of microUS TRUS and targeted biopsies in mpMRI-guided confirmatory biopsies.
Methods: Between October 2017 and September 2021, we prospectively enrolled 100 patients scheduled for MRI-guided confirmatory biopsy at 1 year from diagnosis of ISUP 1 PCa. TRUS was performed using the ExactVu microUS system; PRI-MUS protocol was applied to identify suspicious lesions (i.e., PRIMUS score ≥ 3). All patients received targeted biopsies of any identified microUS and mpMRI lesions and complementary systematic biopsies. The proportion of patients upgraded to clinically significant PCa (defined as ISUP ≥ 2 cancer; csPCa) at confirmatory biopsies was determined, and the diagnostic performance of microUS and mpMRI were compared.
Results: Ninety-two patients had a suspicious MRI lesion classified PI-RADS 3, 4, and 5 in respectively 28, 16, and 18 patients. MicroUS identified 82 patients with suspicious lesions, classified as PRI-MUS 3, 4, and 5 in respectively 20, 50, and 12 patients, while 18 individuals had no lesions. Thirty-four patients were upgraded to ISUP ≥ 2 cancer and excluded from AS. MicroUS and mpMRI showed a sensitivity of 94.1% and 100%, and an NPV of 88.9% and 100%, respectively, in detecting ISUP ≥ 2 patients. A microUS-mandated protocol would have avoided confirmatory biopsies in 18 patients with no PRI-MUS ≥ 3 lesions at the cost of missing four upgraded patients.
Conclusions: MicroUS and mpMRI represent valuable imaging modalities showing high sensitivity and NPV in detecting csPCa, thus allowing their use for event-triggered confirmatory biopsies in AS patients. MicroUS offers an alternative imaging modality to mpMRI for the identification and real-time targeting of suspicious lesions in AS patients.
(© 2023 Wiley Periodicals LLC.)
Databáze: MEDLINE