Detection of Clinically Significant Prostate Cancer Using Micro-Ultrasound vs Magnetic Resonance Imaging/Ultrasound Fusion Biopsy: A Propensity-Weighted Comparative Study.

Abstract

We compare the detection rates of clinically significant prostate cancer (csPCa) between cognitively targeted micro-ultrasound-guided biopsy (MB) and MRI/ultrasound fusion-guided biopsy (PFB) in men with MRI-visible lesions. We retrospectively analyzed 1119 men who underwent MB (n = 767) or PFB (n = 352) between 2019 and 2022. Inverse probability of treatment weighting based on a logistic regression propensity score was applied to balance baseline characteristics between groups. Weighted logistic regression models were used to compare csPCa detection in the overall cohort and in subgroups of biopsy-naïve men and those with anterior lesions. A separate multivariable logistic regression was performed in the full cohort to identify independent predictors of csPCa. Concordance between biopsy and radical prostatectomy Gleason scores was also evaluated. After inverse probability of treatment weighting adjustment, csPCa detection with MB was higher than with PFB in combined sampling (45% vs 34%; odds ratio, 1.61; 95% CI: 1.23-2.11; <i>P</i> < .01). However, no significant difference was observed between techniques for targeted biopsies alone, both in the overall cohort and among biopsy-naïve men. In patients with anterior lesions, csPCa detection rates were also similar. In the full cohort multivariable model, MB and Prostate Imaging-Reporting and Data System 5 lesions were independently associated with csPCa. Gleason upgrading at prostatectomy was more frequent in the PFB group (38% vs 17%; <i>P</i> = .01). While MB demonstrated higher csPCa detection in adjusted analyses, the benefit was not consistent across all settings. Further studies are warranted to determine whether this reflects a methodological advantage or context-dependent factors.