A new type of ultrasound scan Prostate cancerAccording to the test results published in Lancet Oncology .. This is the first study to show that multiparametric ultrasound (mpUSS) can be used to detect clinically significant cases.
The current practice for men at risk for prostate cancer is to use multiparametric magnetic resonance imaging (mpMRI) and then target. Prostate biopsy.. However, MRI scans are expensive and time consuming. In addition, patients with total hip arthroplasty or claustrophobia may not be able to undergo an MRI scan.
Professor Hashim Ahmed, chief author of the Department of Urology at Imperial College London, said, “The pandemic of COVID-19 results in a waiting list of cancers, so we find a more efficient and cheaper test for diagnosing prostate cancer. I need to. “
Multiparametric ultrasound is more readily available than mpMRI, and various case series suggest that it may be an alternative technique for diagnosing clinically important prostate cancer. However, there have been no large studies to verify its effectiveness.
Therefore, researchers at Imperial College London (ICL), University College London (UCL), and the Imperial College Healthcare NHS Trust conducted a prospective pair cohort clinical trial to compare the usefulness of mpUSS and mpMRI. ..
Details of the study
The study, called CADMUS (Multiparametric Ultrasonography of the Prostate), found 370 men over the age of 18 from seven UK hospitals following elevated prostate-specific antigen testing or abnormal findings on a rectal exam. It has been registered. They received both types of scans on separate visits. If any scan showed a suspicious lesion (Likert score 3 or higher), the patient underwent a prostate biopsy.
Of the 306 patients who completed both types of scans, 272 were positive for mpUSS (89%). [95% CI 85-92]) And 238 mpMRI (78%) [73-82]Difference 11.1% [95% CI 5.1 to 17.1]).The positive test agreement was 73.2% (95% CI 67.9 to 78.1; kappa = 0.06). [95% CI -0.56 to 0.17]).
As a result, of the 257 biopsied patients, cancer was detected in 133 men, 83 of whom were considered clinically significant (Gleason score of 4 + 3 or higher in any area). Or defined as maximum cancer core length of 6 mm or more) of any grade [PROMIS definition 1]).
Of the important cases, 66 were detected by mpUSS, while 77 were detected by mpMRI. Combining both tests, 83 cases were detected. 6 cases (7%) [95% CI 3-15]) Was detected only in mpUSS and 17 (20%) [12-31]) Detected exclusively by mpMRI, 91.1% was obtained [95% CI 86.9 to 94.2]Kappa = 0.78 [95% CI 0.69 to 0.86]) Match between two types of scans.
Although mpUSS detected 4.3% less clinically significant prostate cancer than mpMRI, its use would lead to 11.1% more patients referred for biopsy, the authors said.
“Both imaging tests missed clinically significant cancers detected by the other, so using both will detect clinically significant prostate cancer compared to using each test alone. Will increase. “
Professor Ahmed commented:[mpUSS] MRI scans are slightly better, but they can detect most cases of prostate cancer with higher accuracy.
Inexpensive tool
“We believe this test can be used in low- and middle-income environments where access to expensive MRI equipment is difficult and the number of cases of prostate cancer is increasing.”
He said Medscape UK Purchasing an MRI machine costs £ 2 to £ 3 million, and individual tests usually cost £ 350 to £ 450, which takes about 40 minutes. By comparison, purchasing an ultrasound device costs £ 50,000 to £ 100,000. Each test costs £ 50 to £ 100 and takes 20 minutes.
Patient receptivity seems to be similar. “We did not get the feedback reported by the patient,” he said. Although not measured in this study, about 3% of men cannot perform or refuse MRI because of claustrophobia. “
The paper concludes that: “Multiparametric ultrasound may be an alternative to multiparametric MRI as the first test for patients at risk for prostate cancer, especially if multiparametric MRI cannot be performed.”
This study was funded by Jon Moulton Charity Trust, Prostate Cancer UK, and UCLH Charity and Barts Charity.
