Prostate MRI is linked with higher sensitivity, NPV vs micro-ultrasound in pilot study

Recent data presented at the 2025 Society of Urologic Oncology Annual Meeting in Phoenix, Arizona found that MRI of the prostate outperformed micro-ultrasound, although investigators noted the easy learning curve of micro-ultrasound in clinical practice.¹

For the pilot study, the investigators enrolled 31 patients who were suspected of having clinically significant prostate cancer. The entire cohort received a prostate MRI, and the participating urologists were blinded to the MRI results. The investigators performed micro-ultrasound, after which lesions were identified and biopsied. Systemic biopsy was also performed. The urologists were then unblinded to the results and biopsies were performed on lesions that were identified on MRI, with repeat biopsy performed if lesions were identified on both micro-ultrasound and MRI.

Average patient age was 62 years, and 80% were White. Median prostate-specific antigen level of the cohort was 6.9 ng/mL. Of the cohort, 88% had PRIMUS 3, 4, or 5 lesions identified by micro-ultrasound, and 46% had PI-RADS 3, 4, or 5 lesions as identified on MRI.

For micro-ultrasound compared with true cancer status, estimated sensitivity was 0.8000 (standard error, 0.1265; 95% Confidence Limits, 0.5521-1.000). In addition, estimated negative predictive value was 0.8182 (standard error, 0.1163; 95% Confidence Limits, 0.5903-1.000). For MRI compared with true cancer status, estimated sensitivity was 0.900 (standard error, 0.0949; 95% Confidence Limits, 0.7141-1.0000). Estimated negative predictive value was 0.9286 (standard error, 0.0688; 95% Confidence Limits, 0.7937-1.0000). A total of 10 patients received a diagnosis of clinically significant prostate cancer, 8 patients had grade group 1 disease, and 11 patients had benign biopsies. MRI was found to outperform micro-ultrasound in several measures. “When evaluating MRI against true biopsy results, it demonstrated a sensitivity of 90% and a [negative predictive value] of 92%,” the authors wrote in their poster.

“Our finding was MRI performed better compared with micro-ultrasound on most metrics, [including] sensitivity and negative predictive value. However, with a small sample size of just 31 cases, our urologists were able to get better on identifying lesions on micro-ultrasound. This shows that in 1 institution…with a small sample size, [there] is a short learning curve to be able to use micro-ultrasound,” Abdul Qadar, MD, a urology resident at the University of Oklahoma College of Medicine in Oklahoma City, told Urology Times.

Describing his own experience with micro-ultrasound, Qadar said, “I think it's useful, especially if you already have it at your institution. It's easier to identify the lesions. Even if you have an MRI, it's easier to target the lesions on micro-ultrasound vs conventional ultrasound.” He added that micro-ultrasound is also useful for patients who cannot undergo MRI.

Also speaking with Urology Times, study author Andrew McIntosh, MD, FACS, an assistant professor of urology at the University of Oklahoma Health Sciences Center, noted, “No one's claiming that micro-ultrasound is superior to what is now the gold standard, which is an MRI of the prostate. But I do think it gives us the opportunity to transfer some of the diagnostics to the point of care with the urologist, decrease the cost and decrease the stress and logistics of having to do MRIs. Maybe you could do MRIs less, and it allows the urologist to evaluate the prostate in real time [and] make decisions in real time. That’s where I think the advantage might be terrific.”

Qadar noted that he and his colleagues continue to use micro-ultrasound in their institution and hope to expand their study “and see if we can get similar outcomes to the OPTIMUM trial [NCT05220501].” That report, published in JAMA, found that microultrasonography-guided biopsy demonstrated noninferiority to MRI/conventional ultrasonography fusion-guided biopsy in the detection of clinically significant prostate cancer in biopsy-naïve men.

REFERENCES

1. Amason RC, Cookson M, Stratton K, McIntosh A, et al. MRI fusion prostate biopsy vs. micro-ultrasound guided biopsy: A prospective pilot study. Presented at: Society of Urologic Oncology Annual Meeting; December 2-5, 2025; Phoenix, Arizona. Abstract 71. https://suo-abstracts.secure-platform.com/a/gallery/rounds/24/details/4274

2. Kinnaird A, Luger F, Cash H, et al. Microultrasonography-guided vs MRI-guided biopsy for prostate cancer diagnosis: The OPTIMUM randomized clinical trial. JAMA. 2025 May 20;333(19):1679-1687. doi:10.1001/jama.2025.3579