MP49-15 EVALUATING THE ROLE OF PRI-MUS PROTOCOL IN IDENTIFYING CLINICALLY SIGNIFICANT PROSTATE CANCER: A HIGH-VOLUME EXPERIENCE ON MICROULTRASOUND

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV (MP49)1 May 2024MP49-15 EVALUATING THE ROLE OF PRI-MUS PROTOCOL IN IDENTIFYING CLINICALLY SIGNIFICANT PROSTATE CANCER: A HIGH-VOLUME EXPERIENCE ON MICROULTRASOUND Davide Maffei, Pier Paolo Avolio, Stefano Moretto, Andrea Piccolini, Muhannad Aljoulani, Filippo Dagnino, Fabio De Carne, Vittorio Fasulo, Paciotti Marco, Alberto Rosario Saita, Rodolfo Fausto Hurle, Giorgio Ferruccio Guazzoni, Paolo Casale, Nicolò Maria Buffi, Massimo Lazzeri, and Giovanni Lughezzani Davide MaffeiDavide Maffei , Pier Paolo AvolioPier Paolo Avolio , Stefano MorettoStefano Moretto , Andrea PiccoliniAndrea Piccolini , Muhannad AljoulaniMuhannad Aljoulani , Filippo DagninoFilippo Dagnino , Fabio De CarneFabio De Carne , Vittorio FasuloVittorio Fasulo , Paciotti MarcoPaciotti Marco , Alberto Rosario SaitaAlberto Rosario Saita , Rodolfo Fausto HurleRodolfo Fausto Hurle , Giorgio Ferruccio GuazzoniGiorgio Ferruccio Guazzoni , Paolo CasalePaolo Casale , Nicolò Maria BuffiNicolò Maria Buffi , Massimo LazzeriMassimo Lazzeri , and Giovanni LughezzaniGiovanni Lughezzani View All Author Informationhttps://doi.org/10.1097/01.JU.0001008696.31772.28.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Micro-ultrasound (mUS) is a new imaging modality with resolution down to 70 um. The PRI-MUS Risk Identification protocol offers a 5-point Likert scale to define risk of clinically significant prostate cancer (csPCa). This study reports on our clinical experience after introducing mUS into our prostate biopsy clinic and evaluation of the PRI-MUS score. METHODS: Data on 1404 consecutive patients imaged with the ExactVu mUS system between October 2017 and August 2023 were prospectively collected. All patients were scheduled for prostate biopsy due to clinical suspicion of PCa. The PRI-MUS protocol was used to locate targets on mUS. Lesions with a PRI-MUS score ≥3 were targeted. Patients were also subjected to systematic prostatic biopsies. The presence of overall PCa and of clinically significant PCa (defined as a Gleason score ≥7; csPCa) was determined and the diagnostic performance of mUS was assessed. Logistic regression models (LRMs) were fitted to test the predictors of csPCa. RESULTS: Mean age was 66(IQR 60-72) yrs, median total PSA was 7.0(IQR 5-9.8) ng/mL and median prostate volume was 50(IQR 38-65) mL. Overall, 38.3% patients were in the repeat biopsy setting, with 15.3% patients on active surveillance. MUS detected prostate lesions with a PRI-MUS score of 3, 4 and 5 in respectively 128 (9.1%), 622 (44.2%) and 281(20.0%) patients, while in 363(25.8%) individuals mUS did not identify any target. Overall PCa and csPca detection rates were 51.6%(724/1404) and 37.0%(519/1406). Micro-US provided high sensitivity, with 88.2% (458/519) of csPCa patients having at least one PRI-mMUS score ≥3 lesion. Similarly, NPV was 83.0% with 297/358 patients with no micro-US targets receiving a benign or insignificant PCa diagnosis (after systematic and MRI-target biopsy). Conversely, PPV and specificity were lower (43.8% and 33.6%), likely due to over-targeting. CsPCa rate according to PRI-MUS score was in 24.7% (34/137) for PRI-MUS 3, 37.7% (237/628) for PRI-MUS 4 and 66.5% (187/281) for PRI-MUS 5. The ratio between csPCa and overall PCa diagnosed increased with increasing PRIMUS score (58.6%, 68.5% and 92.6% for PRIMUS 3, 4 and 5 lesions). CONCLUSIONS: Our results the accuracy of PRI-MUS protocol in risk stratifying patients undergoing prostate biopsy and differentiate between non-significant and csPCa. MicroUS is a fast and efficient modality for PCa evalution, with high sensitivity and negative predictive value for csPCa as well as allowing lesion identification and targeting. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e788 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Davide Maffei More articles by this author Pier Paolo Avolio More articles by this author Stefano Moretto More articles by this author Andrea Piccolini More articles by this author Muhannad Aljoulani More articles by this author Filippo Dagnino More articles by this author Fabio De Carne More articles by this author Vittorio Fasulo More articles by this author Paciotti Marco More articles by this author Alberto Rosario Saita More articles by this author Rodolfo Fausto Hurle More articles by this author Giorgio Ferruccio Guazzoni More articles by this author Paolo Casale More articles by this author Nicolò Maria Buffi More articles by this author Massimo Lazzeri More articles by this author Giovanni Lughezzani More articles by this author Expand All Advertisement PDF downloadLoading ...