European urology oncology · 2026
Head-to-head Comparison of Multimodal Imaging for Prostate Cancer Detection and Local Staging with Whole-mount Histopathology Reference.
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Miao Qi, Sisk Anthony, Sonni Ida, Grunden Kyla, Ludwig Vinicius, Pang Kaifeng, Walsh Kevin, Klein Jordan, Goldar Zahra Mohammadi, Reiter Robert E, Raman Steven S, Brisbane Wayne G, Sung KyungHyun
Аннотация
BACKGROUND: Accurate detection and local staging of prostate cancer (PCa) remain critical for treatment planning, yet head-to-head multimodal imaging comparisons remain limited.
OBJECTIVE: This study compared microultrasound (microUS), multiparametric magnetic resonance imaging (mpMRI), and prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) for detecting clinically significant PCa (csPCa) and extraprostatic extension (EPE), using whole-mount histopathology (WMHP) as the reference standard.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective study included patients who underwent microUS and mpMRI followed by radical prostatectomy between January 2023 and October 2024. A subset also underwent PSMA PET/CT.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Detection of csPCa and EPE was assessed at the lesion and sector levels using WMHP as a reference. Detection rates and positive predictive values (PPVs) were compared using McNemar and chi-square tests, while sector-level area under the receiver operating characteristic curves (AUCs) were compared using the DeLong test.
RESULTS AND LIMITATIONS: No statistically significant differences were observed between microUS and mpMRI or PSMA PET/CT for index lesion detection (0.90, 0.94, and 0.93, respectively) or csPCa detection (0.71, 0.78, and 0.72, respectively), although the study may have been underpowered to detect small differences. mpMRI had higher PPVs for csPCa than microUS (0.91 vs 0.77, p = 0.03). mpMRI achieved the highest sector-level AUCs for csPCa (0.73) and EPE (0.88). Across modalities, 15-18% of csPCa lesions were missed, which were non-index Grade Group 2 with Gleason pattern 4 ≤20%. The study is limited by its single-center retrospective design.
CONCLUSIONS: MicroUS showed no statistically significant differences compared with mpMRI and PSMA PET/CT for detecting index and csPCa lesions, supporting a potential complementary role in resource-limited or MRI-contraindicated settings.
OBJECTIVE: This study compared microultrasound (microUS), multiparametric magnetic resonance imaging (mpMRI), and prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) for detecting clinically significant PCa (csPCa) and extraprostatic extension (EPE), using whole-mount histopathology (WMHP) as the reference standard.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective study included patients who underwent microUS and mpMRI followed by radical prostatectomy between January 2023 and October 2024. A subset also underwent PSMA PET/CT.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Detection of csPCa and EPE was assessed at the lesion and sector levels using WMHP as a reference. Detection rates and positive predictive values (PPVs) were compared using McNemar and chi-square tests, while sector-level area under the receiver operating characteristic curves (AUCs) were compared using the DeLong test.
RESULTS AND LIMITATIONS: No statistically significant differences were observed between microUS and mpMRI or PSMA PET/CT for index lesion detection (0.90, 0.94, and 0.93, respectively) or csPCa detection (0.71, 0.78, and 0.72, respectively), although the study may have been underpowered to detect small differences. mpMRI had higher PPVs for csPCa than microUS (0.91 vs 0.77, p = 0.03). mpMRI achieved the highest sector-level AUCs for csPCa (0.73) and EPE (0.88). Across modalities, 15-18% of csPCa lesions were missed, which were non-index Grade Group 2 with Gleason pattern 4 ≤20%. The study is limited by its single-center retrospective design.
CONCLUSIONS: MicroUS showed no statistically significant differences compared with mpMRI and PSMA PET/CT for detecting index and csPCa lesions, supporting a potential complementary role in resource-limited or MRI-contraindicated settings.