Head-to-head Comparison of Multimodal Imaging for Prostate Cancer Detection and Local Staging with Whole-mount...

Area of Science:

• Oncology
• Radiology
• Medical Imaging

Background:

• Accurate prostate cancer (PCa) detection and staging are crucial for treatment planning.
• Limited head-to-head comparisons exist for advanced PCa imaging modalities.

Purpose of the Study:

• To compare microultrasound (microUS), multiparametric magnetic resonance imaging (mpMRI), and PSMA PET/CT for detecting clinically significant PCa (csPCa) and extraprostatic extension (EPE).
• To establish whole-mount histopathology (WMHP) as the reference standard for comparison.

Main Methods:

• Retrospective analysis of patients undergoing microUS and mpMRI prior to radical prostatectomy.
• Inclusion of a subset of patients who also underwent PSMA PET/CT.
• Assessment of csPCa and EPE detection rates and positive predictive values (PPVs) using WMHP, with statistical comparisons via McNemar and chi-square tests.

Main Results:

• No significant differences in index lesion or csPCa detection rates were found between microUS, mpMRI, and PSMA PET/CT.
• mpMRI demonstrated higher PPVs for csPCa detection compared to microUS (0.91 vs. 0.77).
• mpMRI achieved the highest sector-level AUCs for csPCa (0.73) and EPE (0.88).
• 15-18% of csPCa lesions were missed across all modalities, primarily smaller, non-index lesions.

Conclusions:

• MicroUS performance is comparable to mpMRI and PSMA PET/CT for detecting index and csPCa lesions.
• MicroUS may play a complementary role in resource-limited settings or for patients with MRI contraindications.
• Further research may be needed to clarify subtle differences and optimize modality selection.