Skip to main content

Advertisement

SpringerLink
Log in

The diagnostic accuracy of micro-ultrasound for prostate cancer diagnosis: a review

  • Topic Paper
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

Micro-UltraSound (microUS) is a new imaging modality capable of identifying and targeting suspicious areas, which might further increase the diagnostic yield of prostate biopsy (PBx). Aim of this review is to provide insights into the usefulness of microUS for the sub-stratification of prostate cancer (PCa), clinically significant PCa (i.e., any Gleason score ≥ 7 PCa; csPCa) along with non-organ-confined disease in patients undergoing PBx.

Methods

A PubMed literature search was performed using keywords: prostate cancer diagnosis, prostate cancer diagnosis surveillance, systematic biopsy, target biopsy, micro-ultrasound, and prostate risk identification using micro-ultrasound.

Results

MicroUS could significantly improve multiparametric magnetic resonance imaging (mpMRI) findings by adding valuable anatomical and pathological information provided by real-time examination. Furthermore, microUS target biopsy could replace systematic biopsy in clinical practice by reducing the detection of clinically insignificant (ciPCa) and increasing that of csPCa. Finally, microUS may be useful in predicting the presence of non-organ confined PCa before radical prostatectomy and it could also be an effective add-on tool for patient monitoring within the active surveillance program.

Conclusion

MicroUS may represent an attractive step forward for the management of csPCa as a complementary or alternative tool to mpMRI. Nevertheless, further longitudinal studies are warranted, and the strength of the evidence is still suboptimal to provide clear recommendations for daily clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Availability of data and materials

Not applicable.

References

  1. Gandaglia G, Albers P, Abrahamsson P-A et al (2019) Structured population-based prostate-specific antigen screening for prostate cancer: the European Association of Urology position in 2019. Eur Urol 76:142–150. https://doi.org/10.1016/j.eururo.2019.04.033

    Article  PubMed  Google Scholar 

  2. Klotz L, Chin J, Black PC et al (2021) Comparison of multiparametric magnetic resonance imaging-targeted biopsy with systematic transrectal ultrasonography biopsy for biopsy-naive men at risk for prostate cancer: a phase 3 randomized clinical trial. JAMA Oncol 7:534. https://doi.org/10.1001/jamaoncol.2020.7589

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kasivisvanathan V, Rannikko AS, Borghi M et al (2018) MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 378:1767–1777. https://doi.org/10.1056/NEJMoa1801993

    Article  PubMed  PubMed Central  Google Scholar 

  4. van der Leest M, Cornel E, Israël B et al (2019) Head-to-head comparison of transrectal ultrasound-guided prostate biopsy versus multiparametric prostate resonance imaging with subsequent magnetic resonance-guided biopsy in biopsy-naïve men with elevated prostate-specific antigen: a large prospective multicenter clinical study. Eur Urol 75:570–578. https://doi.org/10.1016/j.eururo.2018.11.023

    Article  PubMed  Google Scholar 

  5. Rouvière O, Puech P, Renard-Penna R et al (2019) Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study. Lancet Oncol 20:100–109. https://doi.org/10.1016/S1470-2045(18)30569-2

    Article  PubMed  Google Scholar 

  6. Ahmed HU, El-Shater Bosaily A, Brown LC et al (2017) Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 389:815–822. https://doi.org/10.1016/S0140-6736(16)32401-1

    Article  PubMed  Google Scholar 

  7. Ahdoot M, Wilbur AR, Reese SE et al (2020) MRI-targeted, systematic, and combined biopsy for prostate cancer diagnosis. N Engl J Med 382:917–928. https://doi.org/10.1056/NEJMoa1910038

    Article  PubMed  PubMed Central  Google Scholar 

  8. Drost F-JH, Osses DF, Nieboer D et al (2019) Prostate MRI, with or without MRI-targeted biopsy, and systematic biopsy for detecting prostate cancer. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD012663.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kasivisvanathan V, Stabile A, Neves JB et al (2019) Magnetic resonance imaging-targeted biopsy versus systematic biopsy in the detection of prostate cancer: a systematic review and meta-analysis. Eur Urol 76:284–303. https://doi.org/10.1016/j.eururo.2019.04.043

    Article  PubMed  Google Scholar 

  10. Mottet N, van den Bergh RCN, Briers E et al (2021) EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer—2020 update. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 79:243–262. https://doi.org/10.1016/j.eururo.2020.09.042

    Article  CAS  PubMed  Google Scholar 

  11. Sathianathen NJ, Omer A, Harriss E et al (2020) Negative predictive value of multiparametric magnetic resonance imaging in the detection of clinically significant prostate cancer in the prostate imaging reporting and data system era: a systematic review and meta-analysis. Eur Urol 78:402–414. https://doi.org/10.1016/j.eururo.2020.03.048

    Article  PubMed  Google Scholar 

  12. Hugosson J, Månsson M, Wallström J et al (2022) Prostate cancer screening with PSA and MRI followed by targeted biopsy only. N Engl J Med 387:2126–2137. https://doi.org/10.1056/NEJMoa2209454

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Williams C, Ahdoot M, Daneshvar MA et al (2022) Why does magnetic resonance imaging-targeted biopsy miss clinically significant cancer? J Urol 207:95–107. https://doi.org/10.1097/JU.0000000000002182

    Article  PubMed  Google Scholar 

  14. Stabile A, Giganti F, Kasivisvanathan V et al (2020) Factors influencing variability in the performance of multiparametric magnetic resonance imaging in detecting clinically significant prostate cancer: a systematic literature review. Eur Urol Oncol 3:145–167. https://doi.org/10.1016/j.euo.2020.02.005

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hao S, Discacciati A, Eklund M et al (2022) Cost-effectiveness of prostate cancer screening using magnetic resonance imaging or standard biopsy based on the STHLM3-MRI study. JAMA Oncol. https://doi.org/10.1001/jamaoncol.2022.5252

    Article  PubMed  PubMed Central  Google Scholar 

  16. Postema A, Mischi M, de la Rosette J, Wijkstra H (2015) Multiparametric ultrasound in the detection of prostate cancer: a systematic review. World J Urol 33:1651–1659. https://doi.org/10.1007/s00345-015-1523-6

    Article  PubMed  PubMed Central  Google Scholar 

  17. Correas J-M, Halpern EJ, Barr RG et al (2021) Advanced ultrasound in the diagnosis of prostate cancer. World J Urol 39:661–676. https://doi.org/10.1007/s00345-020-03193-0

    Article  PubMed  Google Scholar 

  18. Salib A, Halpern E, Eisenbrey J et al (2022) The evolving role of contrast-enhanced ultrasound in urology: a review. World J Urol. https://doi.org/10.1007/s00345-022-04088-y

    Article  PubMed  Google Scholar 

  19. Ghai S, Eure G, Fradet V et al (2016) Assessing cancer risk on novel 29 MHz micro-ultrasound images of the prostate: creation of the micro-ultrasound protocol for prostate risk identification. J Urol 196:562–569. https://doi.org/10.1016/j.juro.2015.12.093

    Article  PubMed  Google Scholar 

  20. Klotz L, Lughezzani G, Maffei D et al (2020) Comparison of micro-ultrasound and multiparametric magnetic resonance imaging for prostate cancer: a multicenter, prospective analysis. Can Urol Assoc J. https://doi.org/10.5489/cuaj.6712

    Article  PubMed  PubMed Central  Google Scholar 

  21. Pavlovich CP, Hyndman ME, Eure G et al (2021) A multi-institutional randomized controlled trial comparing first-generation transrectal high-resolution micro-ultrasound with conventional frequency transrectal ultrasound for prostate biopsy. BJUI Compass 2:126–133. https://doi.org/10.1002/bco2.59

    Article  CAS  PubMed  Google Scholar 

  22. Fusco F, Emberton M, Arcaniolo D et al (2022) Prostatic high-resolution micro-ultrasound: an attractive step-forward in the management of prostate cancer patients. Prostate Cancer Prostatic Dis. https://doi.org/10.1038/s41391-022-00611-9

    Article  PubMed  Google Scholar 

  23. Cash H, Hofbauer S, Shore N et al (2022) Prostate cancer detection by novice micro-ultrasound users enrolled in a training program. Société Int Urol J 3:62–68. https://doi.org/10.48083/KKVJ7280

    Article  Google Scholar 

  24. Pavlovich CP, Cornish TC, Mullins JK et al (2014) High-resolution transrectal ultrasound: pilot study of a novel technique for imaging clinically localized prostate cancer. Urol Oncol Semin Orig Investig 32:34.e27-34.e32. https://doi.org/10.1016/j.urolonc.2013.01.006

    Article  Google Scholar 

  25. Abouassaly R, Klein EA, El-Shefai A, Stephenson A (2020) Impact of using 29 MHz high-resolution micro-ultrasound in real-time targeting of transrectal prostate biopsies: initial experience. World J Urol 38:1201–1206. https://doi.org/10.1007/s00345-019-02863-y

    Article  PubMed  Google Scholar 

  26. Claros OR, Tourinho-Barbosa RR, Fregeville A et al (2020) Comparison of initial experience with transrectal magnetic resonance imaging cognitive guided micro-ultrasound biopsies versus established transperineal robotic ultrasound magnetic resonance imaging fusion biopsies for prostate cancer. J Urol 203:918–925. https://doi.org/10.1097/JU.0000000000000692

    Article  PubMed  Google Scholar 

  27. Wiemer L, Hollenbach M, Heckmann R et al (2021) Evolution of targeted prostate biopsy by adding micro-ultrasound to the magnetic resonance imaging pathway. Eur Urol Focus 7:1292–1299. https://doi.org/10.1016/j.euf.2020.06.022

    Article  PubMed  Google Scholar 

  28. Rodríguez Socarrás ME, Gomez Rivas J, Cuadros Rivera V et al (2020) Prostate mapping for cancer diagnosis: the madrid protocol. Transperineal prostate biopsies using multiparametric magnetic resonance imaging fusion and micro-ultrasound guided biopsies. J Urol 204:726–733. https://doi.org/10.1097/JU.0000000000001083

    Article  PubMed  Google Scholar 

  29. Hofbauer SL, Luger F, Harland N et al (2022) A non-inferiority comparative analysis of micro-ultrasonography and MRI-targeted biopsy in men at risk of prostate cancer. BJU Int 129:648–654. https://doi.org/10.1111/bju.15635

    Article  PubMed  Google Scholar 

  30. Avolio PP, Lughezzani G, Fasulo V et al (2023) Assessing the role of high-resolution microultrasound among naïve patients with negative multiparametric magnetic resonance imaging and a persistently high suspicion of prostate cancer. Eur Urol Open Sci 47:73–79. https://doi.org/10.1016/j.euros.2022.11.015

    Article  PubMed  Google Scholar 

  31. Cornud F, Lefevre A, Flam T et al (2020) MRI-directed high-frequency (29MhZ) TRUS-guided biopsies: initial results of a single-center study. Eur Radiol 30:4838–4846. https://doi.org/10.1007/s00330-020-06882-x

    Article  CAS  PubMed  Google Scholar 

  32. Pereira-Arias JG, Sánchez-Vázquez A, Gamarra-Quintanilla M, et al ECOGRAFÍA DE ALTA RESOLUCIÓN PROSTÁTICA

  33. Lughezzani G, Maffei D, Saita A et al (2021) Diagnostic accuracy of microultrasound in patients with a suspicion of prostate cancer at magnetic resonance imaging: a single-institutional prospective study. Eur Urol Focus 7:1019–1026. https://doi.org/10.1016/j.euf.2020.09.013

    Article  PubMed  Google Scholar 

  34. Sountoulides P, Pyrgidis N, Polyzos SA et al (2021) Micro-ultrasound–guided vs multiparametric magnetic resonance imaging-targeted biopsy in the detection of prostate cancer: a systematic review and meta-analysis. J Urol 205:1254–1262. https://doi.org/10.1097/JU.0000000000001639

    Article  PubMed  Google Scholar 

  35. You C, Li X, Du Y et al (2022) The microultrasound-guided prostate biopsy in detection of prostate cancer: a systematic review and meta-analysis. J Endourol 36:394–402. https://doi.org/10.1089/end.2021.0361

    Article  PubMed  Google Scholar 

  36. Dias N, Colandrea G, Botelho F et al (2023) Diagnostic accuracy and clinical utility of micro-ultrasound guided biopsies in patients with suspected prostate cancer. Cent Eur J Urol. https://doi.org/10.5173/ceju.2023.198

    Article  Google Scholar 

  37. Ghai S, Perlis N, Atallah C et al (2022) Comparison of micro-US and multiparametric MRI for prostate cancer detection in biopsy-naive men. Radiology 305:390–398. https://doi.org/10.1148/radiol.212163

    Article  PubMed  Google Scholar 

  38. Lorusso V, Kabre B, Pignot G et al (2022) Comparison between micro-ultrasound and multiparametric MRI regarding the correct identification of prostate cancer lesions. Clin Genitourin Cancer 20:e339–e345. https://doi.org/10.1016/j.clgc.2022.01.013

    Article  PubMed  Google Scholar 

  39. Avolio PP, Lughezzani G, Paciotti M et al (2021) The use of 29 MHz transrectal micro-ultrasound to stratify the prostate cancer risk in patients with PI-RADS III lesions at multiparametric MRI: a single institutional analysis. Urol Oncol Semin Orig Investig 39:832.e1-832.e7. https://doi.org/10.1016/j.urolonc.2021.05.030

    Article  Google Scholar 

  40. Fasulo V, Buffi NM, Regis F et al (2022) Use of high-resolution micro-ultrasound to predict extraprostatic extension of prostate cancer prior to surgery: a prospective single-institutional study. World J Urol 40:435–442. https://doi.org/10.1007/s00345-021-03890-4

    Article  CAS  PubMed  Google Scholar 

  41. Pedraza AM, Parekh S, Joshi H et al (2023) Side-specific, microultrasound-based nomogram for the prediction of extracapsular extension in prostate cancer. Eur Urol Open Sci 48:72–81. https://doi.org/10.1016/j.euros.2022.12.005

    Article  PubMed  Google Scholar 

  42. Bhanji Y, Rowe SP, Pavlovich CP (2022) New imaging modalities to consider for men with prostate cancer on active surveillance. World J Urol 40:51–59. https://doi.org/10.1007/s00345-021-03762-x

    Article  PubMed  Google Scholar 

  43. Eure G, Fanney D, Lin J et al (2018) Comparison of conventional transrectal ultrasound, magnetic resonance imaging, and micro-ultrasound for visualizing prostate cancer in an active surveillance population: a feasibility study. Can Urol Assoc J. https://doi.org/10.5489/cuaj.5361

    Article  PubMed  PubMed Central  Google Scholar 

  44. Albers P, Wang B, Broomfield S et al (2022) Micro-ultrasound versus magnetic resonance imaging in prostate cancer active surveillance. Eur Urol Open Sci 46:33–35. https://doi.org/10.1016/j.euros.2022.09.019

    Article  PubMed  PubMed Central  Google Scholar 

  45. Maffei D, Fasulo V, Avolio PP et al (2023) Diagnostic performance of micro-ultrasound at MRI-guided confirmatory biopsy in patients under active surveillance for low-risk prostate cancer. Prostate. https://doi.org/10.1002/pros.24532

    Article  PubMed  Google Scholar 

  46. Harland N, Stenzl A (2021) Micro-ultrasound: a way to bring imaging for prostate cancer back to urology. Prostate Int 9:61–65. https://doi.org/10.1016/j.prnil.2020.12.002

    Article  PubMed  PubMed Central  Google Scholar 

  47. Basso Dias A, Ghai S (2023) Micro-ultrasound: current role in prostate cancer diagnosis and future possibilities. Cancers 15:1280. https://doi.org/10.3390/cancers15041280

    Article  PubMed  PubMed Central  Google Scholar 

  48. Calace FP, Napolitano L, Arcaniolo D et al (2022) Micro-ultrasound in the diagnosis and staging of prostate and bladder cancer: a comprehensive review. Medicina (Mex) 58:1624. https://doi.org/10.3390/medicina58111624

    Article  Google Scholar 

  49. Klotz L, Andriole G, Cash H et al (2022) Optimization of prostate biopsy—micro-ultrasound versus MRI (OPTIMUM): a 3-arm randomized controlled trial evaluating the role of 29 MHz micro-ultrasound in guiding prostate biopsy in men with clinical suspicion of prostate cancer. Contemp Clin Trials 112:106618. https://doi.org/10.1016/j.cct.2021.106618

    Article  PubMed  Google Scholar 

Download references

Funding

Rafael Sanchez-Salas certifies that this research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada

    Pier Paolo Avolio, Maurice Anidjar, Toufic Hassan, Alexis Rompré-Brodeur, Nicolò Maria Buffi & Rafael Sanchez-Salas

  2. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy

    Pier Paolo Avolio & Giovanni Lughezzani

  3. Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy

    Massimo Lazzeri

Authors
  1. Pier Paolo Avolio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giovanni Lughezzani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maurice Anidjar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Toufic Hassan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alexis Rompré-Brodeur
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nicolò Maria Buffi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Massimo Lazzeri
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rafael Sanchez-Salas
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

PPA contributed to project development, data collection, and manuscript writing. GGL contributed to project development and manuscript writing. MA contributed to manuscript writing. TH contributed to data collection. AR-B contributed to manuscript writing. NMB contributed to manuscript writing. ML contributed to manuscript writing. RS-S contributed to project development and manuscript writing.

Corresponding author

Correspondence to Rafael Sanchez-Salas.

Ethics declarations

Conflict of interest

Rafael Sanchez-Salas certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (e.g., employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patent filed, received, or pending), are the following: Nothing to disclose.

Research involving human participants and/or animals

Not applicable.

Informed consent

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 1460 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Avolio, P.P., Lughezzani, G., Anidjar, M. et al. The diagnostic accuracy of micro-ultrasound for prostate cancer diagnosis: a review. World J Urol 41, 3267–3276 (2023). https://doi.org/10.1007/s00345-023-04521-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-023-04521-w

Keywords

Search

Navigation