Upcoming event

Pathologic gleason upgrading following high-resolution micro-ultrasound, conventional ultrasound and MRI fusion biopsy techniques: A comparative study

Introduction & Objectives

Improvements in imaging resolution with micro-ultrasound (MU) compared to conventional ultrasound (TRUS) may enhance the diagnostic accuracy of image-guided prostate biopsy. The objective of this study was to compare pathologic Gleason Grade Group concordance between prostate biopsies performed via TRUS, MRI-guidance, and (MU) approaches and radical prostatectomy (RP).

Materials & Methods

We conducted a retrospective study of patients with PCa diagnosed from January 2021 – June 2023 who underwent Robotic assisted RP following TRUS, MRI or MU biopsy in a multi-site single institution study. We compared the concordance of Gleason grade group (GGG) from biopsy to RP based on the highest GGG identified in any biopsy core and separately based on systematic or targeted biopsy. We examined clinical and pathologic factors associated with pathologic upgrading using descriptive statistics and multivariable logistic regression analysis.


A total of 498 patients were included; 125 (25.1%) received TRUS, 286 (57.4%) MRI and 87 (17.5%) with EV prior to RALP. Patients were similar in terms of age, race, PSA, Prostate volume, and prior biopsy status (p>0.05? – is this fair to say).. 90 (18.1%) patients were upgraded on final pathology (TRUS 28%, MRI 14.7%, EV: 14.9% chi-square p-value?) and 118 were downgraded. The most common upgrade was from GG1 to GG2, and the most common downgrading was GG 3 to GG 2. 18 (20%) of the patients with increased GG, had a ≥2 GG increase. On multivariable analysis, MicroUS/EV and MRI were associated with lower odds of pathological upgrading as compared with TRUS biopsy alone (odds ratio, OR 0.39, 95% CI 0.23-0.68 and OR 0.45 95% CI 0.24-1.04 respectively). However, pairwise comparisons did not reveal significant differences in odds of grade concordance at RP between MU and MRI biopsy (p>0.05). On multivariable logistic regression analysis, higher prostate volume (OR: 1.01, p=0.02), and longer time between biopsy and RALP (OR:1.10, p=<0.001) were independently associated with pathologic Gleason upgrading.


Both micro ultrasound and MRI-ultrasound fusion were associated with improved Gleason grade group concordance between biopsy and RP pathology compared with systematic biopsy. We did not identify significant differences between micro ultrasound and MRI-fusion approaches which may suggest similar benefits in terms of disease sampling.