ArticleEuropean urology oncology2026
Head-to-head Comparison of Multimodal Imaging for Prostate Cancer Detection and Local Staging with Whole-mount Histopathology Reference.
Article in European urology oncology, 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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Abstract
backgroundAccurate detection and local staging of prostate cancer (PCa) remain critical for treatment planning, yet head-to-head multimodal imaging comparisons remain limited.
objectiveThis study compared microultrasound (microUS), multiparametric magnetic resonance imaging (mpMRI), and prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) for detecting clinically significant PCa (csPCa) and extraprostatic extension (EPE), using whole-mount histopathology (WMHP) as the reference standard. DESIGN, SETTING, AND
participantsThis retrospective study included patients who underwent microUS and mpMRI followed by radical prostatectomy between January 2023 and October 2024. A subset also underwent PSMA PET/CT. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Detection of csPCa and EPE was assessed at the lesion and sector levels using WMHP as a reference. Detection rates and positive predictive values (PPVs) were compared using McNemar and chi-square tests, while sector-level area under the receiver operating characteristic curves (AUCs) were compared using the DeLong test. RESULTS AND LIMITATIONS: No statistically significant differences were observed between microUS and mpMRI or PSMA PET/CT for index lesion detection (0.90, 0.94, and 0.93, respectively) or csPCa detection (0.71, 0.78, and 0.72, respectively), although the study may have been underpowered to detect small differences. mpMRI had higher PPVs for csPCa than microUS (0.91 vs 0.77, p = 0.03). mpMRI achieved the highest sector-level AUCs for csPCa (0.73) and EPE (0.88). Across modalities, 15-18% of csPCa lesions were missed, which were non-index Grade Group 2 with Gleason pattern 4 ≤20%. The study is limited by its single-center retrospective design.
conclusionsMicroUS showed no statistically significant differences compared with mpMRI and PSMA PET/CT for detecting index and csPCa lesions, supporting a potential complementary role in resource-limited or MRI-contraindicated settings.
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