Introduction: New technologies have been developed to improve the accuracy of prostate biopsies, including various advanced imaging techniques (multiparametric magnetic resonance imaging [MRI] and high-resolution micro-ultrasound [mUS]). We sought to identify overall and clinically significant prostate cancer (Gleason grade group ≥2; csPCa) detection rates using mUS-guided prostate biopsy.

Methods: From September to December 2021, 90 patients were prospectively entered into an observational cohort, and identified using the Alberta Prostate Cancer Research Initiative (APCaRI) database. All men underwent an MRI/mUS fusion prostate biopsy at the University of Alberta, completed by a single surgeon using the ExactVU device. Anonymous patient and disease-related data were collected and entered into a secure REDCap database. There is no intervention to the patient’s usual care. 

Results: Within our cohort, median age was 65, median prostate serum antigen (PSA) was 7.3 ng/mL, with a corresponding PSA density of 0.13. Patients had multiple indications for receiving a prostate biopsy, including 37 who were biopsy-naive, nine who had prior negative biopsies, 28 on active surveillance (AS) needing a confirmatory biopsy, 15 on AS needing a surveillance biopsy, and one patient who was one year post-focal therapy. Using the Prostate Imaging Reporting and Data System (PI-RADS), 65 (72%) patients had a lesion on MRI that was PI-RADS ≥3. Similarly, using the prostate risk identification using micro-ultrasound (PRI-MUS) risk identification protocol, 69 (77%) patients had a lesion on mUS that was PRI-MUS ≥3. Overall cancer detection rate was 79%, with a csPCa detection rate of 34% (Table 1). csPCa detection rate was 49% in biopsy-naive men; those with PRI-MUS >3 lesions had a csPCa detection rate of 56%, with an overall detection rate of 88%.

Conclusions: Our experience with mUS-guided prostate biopsies suggests an overall and clinically significant cancer detection rate similar to other image-guided biopsy techniques.