Multiparametric ultrasound could be an alternative to multiparametric MRI for prostate cancer detection, according to researchers.
Multiparametric ultrasound detected fewer clinically significant prostate cancers but led to a higher proportion of patients being referred for biopsy. These results were published in The Lancet Oncology.
Researchers conducted the phase 3 CADMUS trial (ClinicalTrials.gov Identifier: NCT02712684) to compare the diagnostic performance of multiparametric ultrasound to multiparametric MRI in patients at risk of prostate cancer who had an elevated prostate-specific antigen concentration or abnormal findings on digital rectal examination.
The trial enrolled 370 patients at 7 hospitals in the UK between March 15, 2016, and November 7, 2019. There were 306 patients who completed both multiparametric ultrasound and multiparametric MRI and 257 who underwent a prostate biopsy.
Researchers identified more suspicious lesions of Likert score 3 or higher in patients who underwent multiparametric ultrasound (89%) compared with those who underwent multiparametric MRI (78%), indicating that the use of multiparametric ultrasound alone would lead to 11.1% more patients being referred for a biopsy. The positive test agreement was 73.2%.
Any cancer was detected in 52% of patients, with 32% being clinically significant cancer according to PROMIS definition 1.
Multiparametric ultrasound detected clinically significant cancer in 26% of patients who underwent biopsies, whereas multiparametric MRI detected clinically significant cancer in 30% of patients, a difference of -4.3%.
When both imaging modalities were combined, clinically significant cancers were detected in 32% of patients. Of these, 7% were solely detected with multiparametric ultrasound, and 20% were detected by multiparametric MRI. The agreement on significant cancer detection was 91.1%.
There were no serious adverse events reported during the study.
“Given that multiparametric ultrasound might be more readily available and accessible in some health care settings than multiparametric MRI, or useful for patients who cannot undergo MRI scans, multiparametric ultrasound should be considered for patients at risk of prostate cancer,” the researchers wrote. “It can also be used in combination with multiparametric MRI to maximize cancer detection.”
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Grey A, Scott R, Shah, B, et al. Multiparametric ultrasound versus multiparametric MRI to diagnose prostate cancer (CADMUS): A prospective, multicentre, paired-cohort, confirmatory study. Lancet Oncol. 2022;23(3):428-438. doi:10.1016/S1470-2045(22)00016-X