Optimizing Prostate Cancer Diagnostic Work‐Up Through Micro‐Ultrasound: Minimizing Unnecessary Procedures and Reducing Overdiagnoses Article Swipe
Edoardo Beatrici
,
Fabio De Carne
,
Nicola Frego
,
Stefano Moretto
,
Marco Paciotti
,
Vittorio Fasulo
,
Alessandro Uleri
,
Giuseppe Garofano
,
Pier Paolo Avolio
,
Giuseppe Chiarelli
,
Roberto Contieri
,
Paola Arena
,
Cesare Saitta
,
Federica Sordelli
,
Alberto Saita
,
Rodolfo Hurle
,
Paolo Casale
,
Nicolò Maria Buffi
,
Massimo Lazzeri
,
Giovanni Lughezzani
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1002/pros.24862
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1002/pros.24862
Introduction We aim to critically assess Microultrasound (mUS) clinical performance in an outpatient setting, focusing on its ability to reduce unnecessary diagnostic procedures, potentially reshape prostate cancer (PCa) diagnostic protocols, and increase the ability to rule out clinically significant (Gleason Score ≥ 3 + 4) PCa (csPCa). Materials and Methods Between November 2018 and April 2022, we conducted a prospective study involving men who underwent mUS examination due to clinical symptoms, PSA elevation, or opportunistic early detection of PCa. Experienced urologists performed mUS assessments in an outpatient setting using the prostate risk identification using micro‐ultrasound (PRI‐MUS) protocol to identify lesions suspicious of csPCa (PRI‐MUS score ≥ 3). Men with negative mUS results were followed through consistent phone follow‐up calls and visits until October 2023 to assess their diagnostic and therapeutic pathways. Using Cox regression models adjusted for PSA levels, DRE results, age, and previous biopsy history, we calculated the hazard ratio (HR) for biopsy‐free (BFS), defined as the time from mUS to biopsy or last follow‐up, cancer‐free survival (CFS), and clinically significant cancer‐free survival (csCFS) within the cohort based on mUS results. Results Overall, 425 men were enrolled. The median (IQR) age was 66 (59–72) years, PSA levels were 5.7 (4.0–7.9) ng/mL, prostate volume was 44 (31.5–62.1) mL, and the median follow‐up was 39 months (27–53). mUS identified lesions suggesting csPCa in 201/425 (47.3%) men. Overall, mUS resulted negative in 224/425 (52.7%) men, of whom 207/224 (92.4%) did not undergo subsequent mpMRI, while 22/224 (9.8%) proceeded with mpMRI according to the referring physician's decision. The latter detected suspicious lesions in 12/22 cases (54.5%), but only 2/12 (16.7%) were confirmed by biopsy as csPCa. Among those with negative mUS results, 192/224 (85.7%) men avoided additional biopsies during follow‐up. Men with negative mUS results exhibited superior BFS (aHR: 0.17; p < 0.001), CFS (aHR:0.12; p < 0.001), and csCFS (aHR:0.09; p < 0.001) survival rates compared to their mUS‐positive counterparts. Conclusions Our findings suggest that mUS can potentially refine patient stratification and transform PCa screening and diagnostic protocols. Pending validation by other studies, a wider implementation of mUS could optimize resource allocation, minimize wastage, and reserve additional costly tests.
Related Topics
Concepts
Medicine
Prostate cancer
Biopsy
Prospective cohort study
Proportional hazards model
Prostate
Hazard ratio
Cancer
Prostate biopsy
Cohort
Urology
Prostate-specific antigen
Stage (stratigraphy)
Internal medicine
Surgery
Confidence interval
Paleontology
Biology
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1002/pros.24862
- OA Status
- hybrid
- Cited By
- 2
- References
- 33
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4406936280
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4406936280Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1002/pros.24862Digital Object Identifier
- Title
-
Optimizing Prostate Cancer Diagnostic Work‐Up Through Micro‐Ultrasound: Minimizing Unnecessary Procedures and Reducing OverdiagnosesWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2025Year of publication
- Publication date
-
2025-01-28Full publication date if available
- Authors
-
Edoardo Beatrici, Fabio De Carne, Nicola Frego, Stefano Moretto, Marco Paciotti, Vittorio Fasulo, Alessandro Uleri, Giuseppe Garofano, Pier Paolo Avolio, Giuseppe Chiarelli, Roberto Contieri, Paola Arena, Cesare Saitta, Federica Sordelli, Alberto Saita, Rodolfo Hurle, Paolo Casale, Nicolò Maria Buffi, Massimo Lazzeri, Giovanni LughezzaniList of authors in order
- Landing page
-
https://doi.org/10.1002/pros.24862Publisher landing page
- Open access
-
YesWhether a free full text is available
- OA status
-
hybridOpen access status per OpenAlex
- OA URL
-
https://doi.org/10.1002/pros.24862Direct OA link when available
- Concepts
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Medicine, Prostate cancer, Biopsy, Prospective cohort study, Proportional hazards model, Prostate, Hazard ratio, Cancer, Prostate biopsy, Cohort, Urology, Prostate-specific antigen, Stage (stratigraphy), Internal medicine, Surgery, Confidence interval, Paleontology, BiologyTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
2Total citation count in OpenAlex
- Citations by year (recent)
-
2025: 2Per-year citation counts (last 5 years)
- References (count)
-
33Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.that | 323 |
| abstract_inverted_index.time | 159 |
| abstract_inverted_index.were | 113, 187, 199, 268 |
| abstract_inverted_index.whom | 235 |
| abstract_inverted_index.with | 109, 247, 276, 289 |
| abstract_inverted_index.(IQR) | 191 |
| abstract_inverted_index.(PCa) | 28 |
| abstract_inverted_index.(aHR: | 296 |
| abstract_inverted_index.(mUS) | 8 |
| abstract_inverted_index.0.17; | 297 |
| abstract_inverted_index.12/22 | 261 |
| abstract_inverted_index.2022, | 56 |
| abstract_inverted_index.Among | 274 |
| abstract_inverted_index.April | 55 |
| abstract_inverted_index.Score | 41 |
| abstract_inverted_index.Using | 132 |
| abstract_inverted_index.based | 179 |
| abstract_inverted_index.calls | 119 |
| abstract_inverted_index.cases | 262 |
| abstract_inverted_index.could | 347 |
| abstract_inverted_index.csCFS | 307 |
| abstract_inverted_index.csPCa | 103, 221 |
| abstract_inverted_index.early | 76 |
| abstract_inverted_index.mpMRI | 248 |
| abstract_inverted_index.other | 340 |
| abstract_inverted_index.phone | 117 |
| abstract_inverted_index.rates | 313 |
| abstract_inverted_index.ratio | 151 |
| abstract_inverted_index.score | 105 |
| abstract_inverted_index.study | 61 |
| abstract_inverted_index.their | 127, 316 |
| abstract_inverted_index.those | 275 |
| abstract_inverted_index.until | 122 |
| abstract_inverted_index.using | 89, 94 |
| abstract_inverted_index.while | 243 |
| abstract_inverted_index.wider | 343 |
| abstract_inverted_index.(9.8%) | 245 |
| abstract_inverted_index.(BFS), | 155 |
| abstract_inverted_index.(CFS), | 169 |
| abstract_inverted_index.0.001) | 311 |
| abstract_inverted_index.22/224 | 244 |
| abstract_inverted_index.assess | 6, 126 |
| abstract_inverted_index.biopsy | 145, 163, 271 |
| abstract_inverted_index.cancer | 27 |
| abstract_inverted_index.cohort | 178 |
| abstract_inverted_index.costly | 356 |
| abstract_inverted_index.csPCa. | 273 |
| abstract_inverted_index.during | 286 |
| abstract_inverted_index.hazard | 150 |
| abstract_inverted_index.latter | 256 |
| abstract_inverted_index.levels | 198 |
| abstract_inverted_index.median | 190, 211 |
| abstract_inverted_index.models | 135 |
| abstract_inverted_index.months | 215 |
| abstract_inverted_index.mpMRI, | 242 |
| abstract_inverted_index.ng/mL, | 202 |
| abstract_inverted_index.reduce | 20 |
| abstract_inverted_index.refine | 327 |
| abstract_inverted_index.tests. | 357 |
| abstract_inverted_index.visits | 121 |
| abstract_inverted_index.volume | 204 |
| abstract_inverted_index.within | 176 |
| abstract_inverted_index.years, | 196 |
| abstract_inverted_index.(16.7%) | 267 |
| abstract_inverted_index.(47.3%) | 224 |
| abstract_inverted_index.(52.7%) | 232 |
| abstract_inverted_index.(85.7%) | 281 |
| abstract_inverted_index.(92.4%) | 237 |
| abstract_inverted_index.(csCFS) | 175 |
| abstract_inverted_index.0.001), | 300, 305 |
| abstract_inverted_index.192/224 | 280 |
| abstract_inverted_index.201/425 | 223 |
| abstract_inverted_index.207/224 | 236 |
| abstract_inverted_index.224/425 | 231 |
| abstract_inverted_index.Between | 51 |
| abstract_inverted_index.Methods | 50 |
| abstract_inverted_index.October | 123 |
| abstract_inverted_index.Pending | 337 |
| abstract_inverted_index.Results | 183 |
| abstract_inverted_index.ability | 18, 34 |
| abstract_inverted_index.avoided | 283 |
| abstract_inverted_index.defined | 156 |
| abstract_inverted_index.lesions | 100, 219, 259 |
| abstract_inverted_index.levels, | 139 |
| abstract_inverted_index.patient | 328 |
| abstract_inverted_index.reserve | 354 |
| abstract_inverted_index.reshape | 25 |
| abstract_inverted_index.results | 112, 292 |
| abstract_inverted_index.setting | 88 |
| abstract_inverted_index.suggest | 322 |
| abstract_inverted_index.through | 115 |
| abstract_inverted_index.undergo | 240 |
| abstract_inverted_index.(54.5%), | 263 |
| abstract_inverted_index.(Gleason | 40 |
| abstract_inverted_index.(csPCa). | 47 |
| abstract_inverted_index.ABSTRACT | 0 |
| abstract_inverted_index.November | 52 |
| abstract_inverted_index.Overall, | 184, 226 |
| abstract_inverted_index.adjusted | 136 |
| abstract_inverted_index.biopsies | 285 |
| abstract_inverted_index.clinical | 9, 70 |
| abstract_inverted_index.compared | 314 |
| abstract_inverted_index.detected | 257 |
| abstract_inverted_index.findings | 321 |
| abstract_inverted_index.focusing | 15 |
| abstract_inverted_index.followed | 114 |
| abstract_inverted_index.history, | 146 |
| abstract_inverted_index.identify | 99 |
| abstract_inverted_index.increase | 32 |
| abstract_inverted_index.minimize | 351 |
| abstract_inverted_index.negative | 110, 229, 277, 290 |
| abstract_inverted_index.optimize | 348 |
| abstract_inverted_index.previous | 144 |
| abstract_inverted_index.prostate | 26, 91, 203 |
| abstract_inverted_index.protocol | 97 |
| abstract_inverted_index.resource | 349 |
| abstract_inverted_index.resulted | 228 |
| abstract_inverted_index.results, | 141, 279 |
| abstract_inverted_index.results. | 182 |
| abstract_inverted_index.setting, | 14 |
| abstract_inverted_index.studies, | 341 |
| abstract_inverted_index.superior | 294 |
| abstract_inverted_index.survival | 168, 174, 312 |
| abstract_inverted_index.wastage, | 352 |
| abstract_inverted_index.(59–72) | 195 |
| abstract_inverted_index.Materials | 48 |
| abstract_inverted_index.according | 249 |
| abstract_inverted_index.conducted | 58 |
| abstract_inverted_index.confirmed | 269 |
| abstract_inverted_index.decision. | 254 |
| abstract_inverted_index.detection | 77 |
| abstract_inverted_index.enrolled. | 188 |
| abstract_inverted_index.exhibited | 293 |
| abstract_inverted_index.involving | 62 |
| abstract_inverted_index.pathways. | 131 |
| abstract_inverted_index.performed | 82 |
| abstract_inverted_index.proceeded | 246 |
| abstract_inverted_index.referring | 252 |
| abstract_inverted_index.screening | 333 |
| abstract_inverted_index.symptoms, | 71 |
| abstract_inverted_index.transform | 331 |
| abstract_inverted_index.underwent | 65 |
| abstract_inverted_index.(27–53). | 216 |
| abstract_inverted_index.(PRI‐MUS | 104 |
| abstract_inverted_index.(aHR:0.09; | 308 |
| abstract_inverted_index.(aHR:0.12; | 302 |
| abstract_inverted_index.additional | 284, 355 |
| abstract_inverted_index.calculated | 148 |
| abstract_inverted_index.clinically | 38, 171 |
| abstract_inverted_index.consistent | 116 |
| abstract_inverted_index.critically | 5 |
| abstract_inverted_index.diagnostic | 22, 29, 128, 335 |
| abstract_inverted_index.elevation, | 73 |
| abstract_inverted_index.identified | 218 |
| abstract_inverted_index.outpatient | 13, 87 |
| abstract_inverted_index.protocols, | 30 |
| abstract_inverted_index.protocols. | 336 |
| abstract_inverted_index.regression | 134 |
| abstract_inverted_index.subsequent | 241 |
| abstract_inverted_index.suggesting | 220 |
| abstract_inverted_index.suspicious | 101, 258 |
| abstract_inverted_index.urologists | 81 |
| abstract_inverted_index.validation | 338 |
| abstract_inverted_index.(4.0–7.9) | 201 |
| abstract_inverted_index.(PRI‐MUS) | 96 |
| abstract_inverted_index.Conclusions | 319 |
| abstract_inverted_index.Experienced | 80 |
| abstract_inverted_index.allocation, | 350 |
| abstract_inverted_index.assessments | 84 |
| abstract_inverted_index.examination | 67 |
| abstract_inverted_index.follow‐up | 118, 212 |
| abstract_inverted_index.performance | 10 |
| abstract_inverted_index.physician's | 253 |
| abstract_inverted_index.potentially | 24, 326 |
| abstract_inverted_index.procedures, | 23 |
| abstract_inverted_index.prospective | 60 |
| abstract_inverted_index.significant | 39, 172 |
| abstract_inverted_index.therapeutic | 130 |
| abstract_inverted_index.unnecessary | 21 |
| abstract_inverted_index.Introduction | 1 |
| abstract_inverted_index.follow‐up, | 166 |
| abstract_inverted_index.follow‐up. | 287 |
| abstract_inverted_index.(31.5–62.1) | 207 |
| abstract_inverted_index.biopsy‐free | 154 |
| abstract_inverted_index.cancer‐free | 167, 173 |
| abstract_inverted_index.counterparts. | 318 |
| abstract_inverted_index.opportunistic | 75 |
| abstract_inverted_index.identification | 93 |
| abstract_inverted_index.implementation | 344 |
| abstract_inverted_index.mUS‐positive | 317 |
| abstract_inverted_index.stratification | 329 |
| abstract_inverted_index.Microultrasound | 7 |
| abstract_inverted_index.micro‐ultrasound | 95 |
| cited_by_percentile_year.max | 97 |
| cited_by_percentile_year.min | 95 |
| corresponding_author_ids | https://openalex.org/A5032746256 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 20 |
| corresponding_institution_ids | https://openalex.org/I4210163047 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/3 |
| sustainable_development_goals[0].score | 0.6899999976158142 |
| sustainable_development_goals[0].display_name | Good health and well-being |
| citation_normalized_percentile.value | 0.92668063 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | True |