INTRODUCTION AND OBJECTIVE:
Prostate cancer (PCa) is the second most commonly diagnosed cancer in males. A prostate biopsy is a gold standard in PCa diagnosis, but unnecessary biopsies and missed cancers are a subject of controversy, especially in the PSA gray zone (2-10ng/ml). EAU guidelines recommend the use of imaging to avoid unnecessary biopsies in males with a PSA in the gray zone. Prostate Micro-ultrasound (MUS) is a brand new and a very promising technology that operates at high frequency (29MHz), therefore it allows extremely precious visualization of the prostate that significantly improves detection of suspicious prostate lesions and provides the advantage of live targeting. Extremely few data exist on the use of MUS guided prostate biopsy (MUS-bx) for the diagnosis of prostate cancer. In this study, we present our pilot experience on MUS-bx in prostate cancer detection.
Between January 2020 and November 2020, a total of 146 men underwent transrectal prostate MUS-bx using a 29MHz transrectal probe. Prostate biopsies were performed in case of abnormally elevated PSA and/or suspicious prostatic imaging. All suspicious lesions were rated with the protocol of prostate risk identification using micro-ultrasound (PRI-MUS) by 3 urologists and a radiologist simultaneously. Suspicious prostate areas were biopsied whenever lesions were identified; in addition, 12 core systematic biopsies were performed in the same patients. Cancer detection rates were analyzed separately for targeted, systematic and targeted plus systematic biopsies. Totally 108 patients with mean PSA 12ng/ml (range 0.2-137ng/ml) did receive systematic plus targeted prostate biopsy. 79 (out of 108) patients with PSA 2-10ng/ml were analyzed separately.
Of the 108 men enrolled in the analysis, PCa would be diagnosed via only targeted biopsy in 22% and via only systematic biopsy in 40%. But, targeted plus systematic biopsy detected prostate cancer in 44% of cases. Out of 79 patients with serum PSA levels 2-10ng/ml PCa detection rate with targeted, systematic, and targeted plus systematic biopsy was 23%, 38%, and 43% accordingly.
MUS-bx is a very effective method of prostate cancer detection. It allows live targeting of the suspicious PCa lesions, perfect visualization of prostate zonal anatomy and consequent highly precious sampling of appropriate prostate zones. Due to these advantages, MUS-bx has the great potential to improve prostate cancer detection and to reduce unnecessary biopsies, especially in PSA gray zone. These findings need confirmation by further studies. See details