This report presents our early experience at Cleveland Clinic replacing conventional ultrasound with a novel 29 MHz high-resolution micro-ultrasound system for both systematic sampling and real-time targeting of suspicious regions during prostate biopsy. The added value of micro-ultrasound and MRI over systematic biopsy is presented.
Sixty-seven consecutive subjects (January–August 2018) from our prospective database who underwent prostate biopsy using the micro-ultrasound system were included. 19/67 had prostate MRI imaging available. MRI targets were sampled using the UroNav fusion system. Patients had a median PSA of 5.37 ng/mL (IQR 4.13–8.74).
38/67 (56.7%) subjects were positive for prostate cancer. In six of these cases, systematic biopsy was negative with only micro-ultrasound targeted samples detecting cancer. In two other cases, patients were upgraded from Grade Group 1 to Grade Groups 4 and 2 based on micro-ultrasound targets. Micro-ultrasound targets detected cancer in two subjects where MRI was negative (Grade Groups 3 and 2). MRI targets alone did not change the overall diagnosis of any subjects. Switching biopsy guidance to real-time micro-ultrasound increased detection rate on prostate biopsy from 44.8% (30/67) to 56.7% (38/67), a relative increase of 26.7%.
High-resolution micro-ultrasound identified clinically significant cancer that would have, otherwise, been missed by both MRI fusion and systematic biopsy and was useful in both biopsy naïve and repeat negative patients. Early results from this small, single-center cohort are promising, particularly given the ease with which micro-ultrasound can replace the conventional ultrasound in standard prostate biopsy procedures.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Siegel RL, Miller KD, Jemal A (2019) Cancer statistics, 2019. CA Cancer J Clin 69(1):7–34. https://doi.org/10.3322/caac.21551
Walz J, Graefen M, Chun FKH et al (2006) High incidence of prostate cancer detected by saturation biopsy after previous negative biopsy series. Eur Urol 50(3):498–505. https://doi.org/10.1016/j.eururo.2006.03.026
NCCN Clinical Practice Guidelines in Oncology V1.2019 (2019) Prostate cancer early detection recommendations. Natl Compr Cancer Network, Inc. https://www.nccn.org/professionals/physician_gls/pdf/prostate_detection.pdf. Accessed 16 April 2019
Rosenkrantz AB, Verma S, Choyke P, et al (2016) Prostate magnetic resonance imaging and magnetic resonance imaging targeted biopsy in patients with a prior negative biopsy: a consensus statement by AUA and SAR. J Urol 196:1613–1618. https://doi.org/10.1016/j.juro.2016.06.079
Mottet N, van den Bergh RCN, Briers E et al (2019) EAU guidelines: prostate cancer. In: EAU annual congress Barcelona, 2019. EAU Guidelines Office, Arnhem, The Netherlands. http://uroweb.org/guidelines/compilations-of-all-guidelines/
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(2):562–569. https://doi.org/10.1016/j.juro.2015.12.093
Marks L, Young S, Natarajan S (2013) MRI-ultrasound fusion for guidance of targeted prostate biopsy. Curr Opin Urol 23(1):43–50. https://doi.org/10.1097/MOU.0b013e32835ad3ee
Cooperberg MR, Carroll PR, Klotz L (2011) Active surveillance for prostate cancer: progress and promise. J Clin Oncol. https://doi.org/10.1200/jco.2011.34.9738
Moyer VA (2012) Screening for prostate cancer: U.S. preventive services task force recommendation statement. Ann Intern Med 157(2):120–134. https://doi.org/10.7326/0003-4819-157-2-201207170-00459
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 6736(16):1–8. https://doi.org/10.1016/S0140-6736(16)32401-1
Kasivisvanathan V, Rannikko AS, Borghi M et al (2018) MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med. https://doi.org/10.1056/nejmoa1801993
Siddiqui MM, Rais-Bahrami S, Turkbey B et al (2015) Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA 313(4):390. https://doi.org/10.1001/jama.2014.17942
Schoots IG, Roobol MJ, Nieboer D, Bangma CH, Steyerberg EW, Hunink MGM (2015) Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. Eur Urol 68(3):438–450. https://doi.org/10.1016/j.eururo.2014.11.037
Fütterer JJ, Briganti A, De Visschere P et al (2015) Can clinically significant prostate cancer be detected with multiparametric magnetic resonance imaging? A systematic review of the literature. Eur Urol 68(6):1045–1053. https://doi.org/10.1016/j.eururo.2015.01.013
van Hove A, Savoie PH, Maurin C et al (2014) Comparison of image-guided targeted biopsies versus systematic randomized biopsies in the detection of prostate cancer: a systematic literature review of well-designed studies. World J Urol 32(4):847–858. https://doi.org/10.1007/s00345-014-1332-3
Lughezzani G, Saita A, Lazzeri M et al (2018) Comparison of the diagnostic accuracy of micro-ultrasound and magnetic resonance imaging/ultrasound fusion targeted biopsies for the diagnosis of clinically significant prostate cancer. Eur Urol Oncol. https://doi.org/10.1016/j.euo.2018.10.001
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed were in accordance and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards and ethical approval was obtained from the Cleveland Clinic’s Institutional Review Board (IRB study 12-118).
Informed consent was obtained from all individual participants included in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Abouassaly, R., Klein, E.A., El-Shefai, A. et al. 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 (2020). https://doi.org/10.1007/s00345-019-02863-y
- Prostate cancer