MRI vs Transrectal Ultrasound to Estimate Prostate Volume and PSAD: Impact on Prostate Cancer Detection

• Published in: Urology (Ridgewood, N.J.) N.J.), 2023-01, Vol.171, p.172-178
• Main Authors: Choe, Shawn, Patel, Hiten D., Lanzotti, Nicholas, Okabe, Yudai, Rac, Goran, Shea, Steven M., Gorbonos, Alex, Quek, Marcus L., Flanigan, Robert C., Goldberg, Ari, Gupta, Gopal N.
• Format: Article
• Language: English
• Subjects: Humans; Image-Guided Biopsy - methods; Magnetic Resonance Imaging - methods; Male; Prostate - diagnostic imaging; Prostate - pathology; Prostate-Specific Antigen; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2022.09.007

To compare multiparametric magnetic resonance imaging (mpMRI) and transrectal ultrasound (TRUS) to estimate prostate volume and prostate specific antigen density (PSAD) as well as subsequent impact on prostate cancer (PCa) detection. Patients referred for mpMRI prior to mpMRI-TRUS fusion-guided prostate biopsy between 2015 and 2020 were identified. Volume and calculated PSAD by mpMRI and TRUS were compared. Associations with presence of any PCa and clinically significant PCa (csPCa; Gleason ≥3 + 4) were evaluated using linear regression (interaction by volume quartile), logistic regression, and receiver operating characteristics. Among 640 men, TRUS underestimated prostate volume relative to mpMRI (median 49.2cc vs. 54.1cc) with 8% lower volume per cc up to 77.5cc (First-third quartile) and 39% lower volume per additional cc above 77.5cc (fourth quartile). For men undergoing radical prostatectomy, mpMRI had a higher correlation coefficient relative to TRUS (0.913 vs 0.878) when compared to surgical pathology. mpMRI PSAD had slightly higher odds vs TRUS PSAD for detecting any PCa (OR 2.94 and OR 2.78, both P