Detection of clinically significant prostate cancer using targeted MRI-informed microultrasound biopsy

Allison B Forrest; Danielle E Kruse; Brian Calio; Michael C Ivey; Jeffrey Gahan; Martus Gn; Rajan T Gupta; Tara Morgan

doi:10.1007/s00330-025-12136-5

Detection of clinically significant prostate cancer using targeted MRI-informed microultrasound biopsy

Eur Radiol. 2025 Nov 22. doi: 10.1007/s00330-025-12136-5. Online ahead of print.

Authors

Allison B Forrest^#¹, Danielle E Kruse^#¹, Brian Calio², Michael C Ivey¹, Jeffrey Gahan², Martus Gn², Rajan T Gupta^{3

4

5}, Tara Morgan²

Affiliations

¹ Department of Radiology, Duke University Medical Center, Durham, NC, USA.
² Department of Urology, Duke University, Raleigh, NC, USA.
³ Department of Radiology, Duke University Medical Center, Durham, NC, USA. rajan.gupta@duke.edu.
⁴ Department of Urology, Duke University, Raleigh, NC, USA. rajan.gupta@duke.edu.
⁵ Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA. rajan.gupta@duke.edu.

^# Contributed equally.

PMID: 41273426
DOI: 10.1007/s00330-025-12136-5

Abstract

Objectives: This study compares the rate of detection of clinically significant prostate cancer (csPCa) using multiparametric MRI (mpMRI)-informed microultrasound-guided (microUS) biopsy to historical published data using mpMRI-ultrasound (mpMRI-US) fusion biopsy at the same institution.

Materials and methods: A single-center retrospective study of patients who underwent mpMRI-informed microultrasound-guided (microUS) biopsy was performed. Positive predictive value (PPV) of targeted lesions by PI-RADS and PRI-MUS (Prostate Risk Identification Using Microultrasound) was calculated and compared to published data using an mpMRI-US fusion platform.

Results: 169 subjects and 244 total lesions were identified by mpMRI. 44/244 (18.0%), 167/244 (68.4%), and 33/244 (13.5%) were PI-RADS 5, 4, and 3, respectively. 206/244 (84.4%) lesions seen on mpMRI were identified on microUS. 26 additional lesions were identified by microUS only. PCa was identified in 120/169 (71.0%) patients, and csPCa was identified in 70/169 (41.4%) by targeted microUS-guided biopsy of MRI lesions. Targeted biopsy of lesions seen only on microUS added three cases of csPCa (73/169, 43.2%). PPV of targeted PI-RADS 5, 4, and 3 lesions for all PCa and csPCa was 0.80, 0.61, and 0.39, and 0.64, 0.31, and 0.12, respectively. Findings were not significantly different compared to historical data using mpMRI-US fusion biopsy (p > 0.05). PPV for csPCa was 0.18 for mpMRI lesions when no correlate was identified by microUS, compared to 0.37 for lesions when a correlate was seen (p < 0.05).

Conclusions: This retrospective study demonstrates successful implementation of microUS-guided biopsy, with similar rates of identification of csPCa compared to historical data using mpMRI-US fusion.

Key points: Question There is limited real-world comparison of the rate of detection of clinically significant prostate cancer using mpMRI-informed microUS-guided biopsy compared to historical mpMRI-ultrasound fusion biopsy. Findings Identification of clinically significant prostate cancer by microUS-guided biopsy was similar to mpMRI-US fusion biopsy, suggesting microUS-guided biopsy performs as well as mpMRI-US fusion biopsy. Clinical relevance Our study shows the complementary role of mpMRI and microUS for the detection of clinically significant prostate cancer, supporting the combined approach of these techniques.

Keywords: Image-guided biopsy; Multiparametric magnetic resonance imaging; Prostate cancer; Ultrasound.