Micro-ultrasound in Cancer Active Surveillance: Enhancing Ultrasound Detection

Accurate assessment of tumor grade is essential in managing prostate cancer (PCa) through Active Surveillance (AS), as it significantly influences treatment decisions. Recent advancements in imaging technologies, particularly high-resolution micro-ultrasound (microUS) and multiparametric magnetic resonance imaging (MRI), show promise in enhancing tumor risk stratification. In a prospective, paired diagnostic trial conducted at an academic tertiary care center, 210 men diagnosed with Gleason Grade Group 1 PCa were evaluated to compare the effectiveness of microUS versus MRI for detecting Gleason Grade Group ≥2 during AS. As of October 2023, 106 men consented to the study, and 63 participants underwent confirmatory biopsies, with pathology results available for analysis. Preliminary findings indicated that the average age of participants was 62.2 years, with a median PSA level of 7.4 ng/mL. Notably, 73% of the men had a PRI-MUS score of ≥3, while 57% presented with a PI-RADS score of ≥3. The analysis revealed that Gleason Grade Group ≥2 was identified in 27 men, accounting for 43% of the cohort. Importantly, there was no statistically significant difference in detecting Gleason Grade Group ≥2 between the two imaging modalities, with microUS combined with systematic biopsy and MRI/US Fusion with systematic biopsy detecting all cases of upgrading (p=0.99). These findings suggest that both microUS and MRI provide comparable accuracy in identifying clinically significant prostate cancer during active surveillance, which may guide future diagnostic strategies and patient management.