Bimodal imaging: Detection rate of clinically significant prostate cancer is higher in MRI lesions visible to transrectal ultrasound

Abstract

AbstractBackgroundTo explore the detection rates of clinically significant prostate cancer (csPCa; ISUP ≥2) in patients with a single MRI lesion that is visible or invisible on transrectal ultrasound (TRUS) during biopsy.MethodsRetrospective analyses of patients who underwent targeted and systematic biopsy of the prostate for one MRI‐visible lesion (PI‐RADS score ≥ 3) between 2017 and 2022. TRUS‐visibility, PI‐RADS score, and clinical parameters were recorded prospectively. Univariable and multivariable logistic regression models were used to identify predictors of csPCa.Results277 consecutive patients with one MRI‐visible lesion were identified. A correlating lesion on TRUS was present in 147/277 (53%). The median age, PSA level, and prostate volume were 68.0 years (IQR: 62.0–73.0), 7.3 ng/ml (IQR: 5.4–10.8) and 45.0 cc (IQR: 32.0–68.0), respectively. Baseline parameters were not significantly different between the two groups. CsPCa was detected in 59/130 (45%) without and in 102/147 (69%) patients with a corresponding TRUS lesion. In multivariable logistic regression analysis predicting csPCa, TRUS‐visibility (OR: 2.13, CI: 1.14–4.03, p = 0.02) and PI‐RADS score (PI‐RADS 4: OR: 7.28, CI: 3.33–17.19; PI‐RADS 5: OR: 13.39, CI: 5.27–36.83, p < 0.001) achieved independent predictor status.ConclusionsBimodal‐visible lesions more often harbored csPCa and were easier to target. TRUS‐visibility of MRI lesions is an independent predictor of csPCa. Therefore, education in both modalities is essential. Despite MRI, the ultrasound should still be diligently examined.