Pd13-12 Diagnostic Performance of Microultrasound at Confirmatory Reclassification Biopsy in Patients Under Active Surveillance for Low-Risk Prostate Cancer

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I (PD13)1 May 2024PD13-12 DIAGNOSTIC PERFORMANCE OF MICROULTRASOUND AT CONFIRMATORY RECLASSIFICATION BIOPSY IN PATIENTS UNDER ACTIVE SURVEILLANCE FOR LOW-RISK PROSTATE CANCER Filippo Dagnino, Davide Maffei, Vittorio Fasulo, Pier Paolo Avolio, Stefano Moretto, Andrea Piccolini, Muhannad Aljoulani, Fabio De Carne, Cesare Saitta, Edoardo Beatrici, Luisa Pasini, Silvia Zandegiacomo, Marco Paciotti, Massimo Lazzeri, Alberto Saita, Rodolfo Hurle, Giorgio Guazzoni, Paolo Casale, Nicolò Maria Buffi, and Giovanni Lughezzani Filippo DagninoFilippo Dagnino , Davide MaffeiDavide Maffei , Vittorio FasuloVittorio Fasulo , Pier Paolo AvolioPier Paolo Avolio , Stefano MorettoStefano Moretto , Andrea PiccoliniAndrea Piccolini , Muhannad AljoulaniMuhannad Aljoulani , Fabio De CarneFabio De Carne , Cesare SaittaCesare Saitta , Edoardo BeatriciEdoardo Beatrici , Luisa PasiniLuisa Pasini , Silvia ZandegiacomoSilvia Zandegiacomo , Marco PaciottiMarco Paciotti , Massimo LazzeriMassimo Lazzeri , Alberto SaitaAlberto Saita , Rodolfo HurleRodolfo Hurle , Giorgio GuazzoniGiorgio Guazzoni , Paolo CasalePaolo Casale , Nicolò Maria BuffiNicolò Maria Buffi , and Giovanni LughezzaniGiovanni Lughezzani View All Author Informationhttps://doi.org/10.1097/01.JU.0001009552.62973.71.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) is the primary management strategy for low-risk prostate cancer (Pca). However, the periodic monitoring of AS patients presents challenges. In recent years, microultrasound (mUS) has emerged as a high-resolution transrectal ultrasound (TRUS) modality with high accuracy in detecting Pca. Our aim is to evaluate the impact and diagnostic accuracy of mUS in AS patients undergoing surveillance biopsies. METHODS: From October 2017 to August 2023, we prospectively enrolled 215 patients with ISUP 1 Pca undergoing mUS-guided surveillance biopsies during AS. TRUS was performed using the ExactVu microUS system, applying the PRIMUS protocol to identify suspicious lesions (PRIMUS score≥3). All patients received targeted biopsies of any identified mUS lesions and, if available, MRI lesions, along with complementary systematic biopsies. We determined the proportion of patients upgraded to clinically significant PCa (defined as ISUP≥2 cancer; csPCa) and assessed the diagnostic performance of mUS and mUS-targeted biopsies. RESULTS: Overall, 146 (67.9%) patients had suspicious lesions identified using mUS. The number of lesions identified was 1, 2, and 3 in 109 (74.6%), 29 (19.8%), and 8 (5.4%) patients, respectively. The index lesions were classified as PRI-MUS 3, 4, and 5 in 29 (19.8%), 97 (66.4%), and 20 (13.7%) patients, respectively. No mUS suspicious lesions (i.e., PRI-MUS ≤2) were identified in 69 (32.1%) individuals. Out of 167 (77.6%) patients with available MRI, 140 (83.8%) had PI-RADS ≥3 lesions that received targeted sampling. Upon histopathological examination, 65 (30.2%) were confirmed with ISUP 1 PCa, while 75 (34.8%) patients were upgraded to ISUP≥2 PCa. MicroUS showed a sensitivity, specificity, PPV, and NPV of 89.3%, 43.5%, 45.8%, and 88.4%, respectively, in identifying patients with csPCa. Of the 75 csPCa cases detected, 16 patients (21.3%) were identified solely with MicroUS-targeted cores, 13 (17.3%) with systematic cores only, and 46 (61.3%) by either modality, while 3 (4.0%) were identified solely with MRI-targeted cores. The csPCa detection rate of different biopsy strategies was calculated to be 69.3% for a microUS-targeted only biopsy approach and 77.3% for a systematic-only biopsy approach. An AS microUS-mandated protocol would have spared surveillance biopsies in 69 (32.1%) patients with no PRI-MUS≥3 lesions at the cost of missing eight (11.5%) upgraded patients. CONCLUSIONS: Microultrasound represents a valuable and feasible imaging tool with high sensitivity and NPV in detecting csPCa, allowing its implementation for surveillance biopsies in AS protocols. Therefore, mUS is an accurate imaging modality for identifying and real-time targeting suspicious lesions in AS patients. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e267 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Filippo Dagnino More articles by this author Davide Maffei More articles by this author Vittorio Fasulo More articles by this author Pier Paolo Avolio More articles by this author Stefano Moretto More articles by this author Andrea Piccolini More articles by this author Muhannad Aljoulani More articles by this author Fabio De Carne More articles by this author Cesare Saitta More articles by this author Edoardo Beatrici More articles by this author Luisa Pasini More articles by this author Silvia Zandegiacomo More articles by this author Marco Paciotti More articles by this author Massimo Lazzeri More articles by this author Alberto Saita More articles by this author Rodolfo Hurle More articles by this author Giorgio Guazzoni More articles by this author Paolo Casale More articles by this author Nicolò Maria Buffi More articles by this author Giovanni Lughezzani More articles by this author Expand All Advertisement PDF downloadLoading ...