The combined value of mpUS and mpMRI-TRUS fusion for the diagnosis of clinically significant prostate cancer.

Objective: To evaluate the combined efficacy of multiparametric ultrasonography (mpUS) and multiparametric magnetic resonance imaging/transrectal ultrasound (mpMRI-TRUS) fusion for detecting clinically significant prostate cancer (csPCa).

Methods: From November 2019 to September 2021, biopsy-naïve patients underwent mpMRI-TRUS fusion imaging combined with mpUS-guided targeted biopsies (TB) and systematic biopsies (SB). To further evaluate the additional diagnostic value of mpUS, the imaging features of 202 focus obtained from fusion imaging were assessed. The diagnostic accuracies of mpMRI-TRUS fusion imaging and the combination of mpMRI-TRUS fusion imaging with mpUS for csPCa were comparatively evaluated.

Results: A total of 202 prostate lesions (160 patients) were included in the final analysis, of which 105 were csPCa, 16 were ciPCa, and 81 were noncancerous. The median patient age was 69 (65-73) years and the median tPSA was 22.07 (11.22-62.80) ng/mL. For csPCa, the detection rate of TB was higher than that of SB (50.0% vs. 45.5%, p < 0.05). The imaging characteristics of mpUS in the PCa and non-PCa groups were significantly different (p < 0.001). When compared with mpMRI-TRUS fusion imaging, the positive predictive value, false positive rate, and area under the curve (AUC) of csPCa diagnosis by mpMRI-TRUS fusion imaging combined with mpUS increased by 11.30%, decreased by 19.58%, and increased from 0.719 to 0.770 (p < 0.05), respectively.

Conclusion: TB can improve the detection rate of csPCa and hence can be effectively used in the diagnosis and risk assessment of csPCa. The mpUS-enriched valuable diagnostic information for mpMRI-TRUS fusion imaging and their combination showed a higher diagnostic value for csPCa, which can guide subsequent clinical treatment.