Ultrasound echogenicity is complementary to PI-RADS for risk stratification of clinically significant prostate cancer.

Garret Wegner, Amir Khan, Michael Panagos, Shu Wang, Alexa Van Besien, Michael Naslund, Mohummad Minhaj Siddiqui

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Article in Prostate cancer and prostatic diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

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7 authors.

Garret WegnerDivision of Urology, Department of Surgery, University of Maryland, School of Medicine, Baltimore, MD, USA.

Amir KhanDivision of Urology, Department of Surgery, University of Maryland, School of Medicine, Baltimore, MD, USA.ORCID http://orcid.org/0000-0003-1074-7290

Michael PanagosDivision of Urology, Department of Surgery, University of Maryland, School of Medicine, Baltimore, MD, USA.

Shu WangDivision of Urology, Department of Surgery, University of Maryland, School of Medicine, Baltimore, MD, USA.

Alexa Van BesienDivision of Urology, Department of Surgery, University of Maryland, School of Medicine, Baltimore, MD, USA.

Michael NaslundDivision of Urology, Department of Surgery, University of Maryland, School of Medicine, Baltimore, MD, USA.

Mohummad Minhaj SiddiquiDivision of Urology, Department of Surgery, University of Maryland, School of Medicine, Baltimore, MD, USA. msiddiqui@som.umaryland.edu.ORCID http://orcid.org/0000-0002-4484-6820

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe combination of multiparametric magnetic resonance imaging (MP-MRI) and ultrasound-guided fusion biopsy is increasingly recognized as a valuable tool for diagnosing prostate cancer. However, up to 80% of PI-RADS 3 lesions and 50% of PI-RADS 4 lesions are benign. This study evaluates whether lesion echogenicity observed during MRI-ultrasound fusion biopsy is associated with detecting clinically significant prostate cancer (csPCa).

methodsIn this retrospective analysis (March 2017-February 2022), we reviewed patients who underwent both standard 12-core random biopsies and targeted MP-MRI/US fusion-guided biopsies at our institution. Lesions were categorized as strongly hypoechoic, weakly hypoechoic, or non-hypoechoic based on ultrasound echogenicity. CsPCa was defined as a Gleason score ≥7.

resultsAmong 222 biopsy patients, 59.3% were diagnosed with PCa, and 68% had csPCa. Of 420 lesions, 19.1% were strongly hypoechoic (45% csPCa), 29.5% were weakly hypoechoic (25% csPCa), and 51.4% were non-hypoechoic (11.8% csPCa) (p < 0.001). Echogenicity improved csPCa detection for PI-RADS ≤ 3 lesions from 7.5% (non-hypoechoic) to 27.5% (strongly hypoechoic), for PI-RADS 4 from 13.1% to 35.1%, and for PI-RADS 5 from 42% to 63.5%. The ROC analysis demonstrated AUCs of 0.6958 for PI-RADS, 0.6929 for echogenicity, and 0.7434 for their combination (all p < 0.001).

conclusionLesion echogenicity observed during MRI-ultrasound fusion biopsy enhances csPCa detection and complements PI-RADS scoring. Incorporating echogenicity into risk assessment may improve biopsy decision-making and diagnostic accuracy.

Indexed as

Multiparametric Magnetic Resonance ImagingProstatic NeoplasmsAgedHumansImage-Guided BiopsyMagnetic Resonance ImagingMaleMiddle AgedNeoplasm GradingRetrospective StudiesRisk AssessmentUltrasonography

Identifiers

PMID41053252

DOI10.1038/s41391-025-01033-z

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.