Prostate Cancer Detection by Novice Micro-Ultrasound Users Enrolled in a Training Program

  • Hannes Cash
  • Sebastian Hofbauer
  • Neal Shore
  • Christian P. Pavlovich
  • Stephan Bulang
  • Martin Schostak
  • Erik Planken
  • Joris J. Jaspars
  • Ferdinand Luger
  • Laurence Klotz
  • Georg Salomon
Keywords: Prostate cancer, targeted biopsy, prostate biopsy, micro-ultrasound, PRI-MUS, 29MHz, learning curve


Objective: Micro-ultrasound is an imaging modality used to visualize and target prostate cancer during transrectal
or transperineal biopsy. We evaluated the effectiveness of a micro-ultrasound training program and estimated the
learning curve for prostate biopsy.
Methods: A training program registry was assessed for the rate of clinically significant prostate cancer (csPCa,
grade group ≥ 2), negative predictive value, and specificity at each stage of the program. Nine metrics of biopsy quality
were evaluated in 4 stages for each practitioner. Non-linear fitting and logistic regression models were used to evaluate
the time-course of these metrics over training.
Results: Thirteen practitioners from 8 institutions completed stages 1 to 3 of the program, and 9 completed all 4
stages. Over 1190 micro-ultrasound biopsy procedures were performed. Detection of csPCa increased from 40% to
57% from stage 1 to stage 4 (P < 0.01). Stage 4 “expert” level was independently associated with higher detection of
csPCa when correcting for overall risk factors (OR 1.95; P = 0.03). Limitations include the retrospective analysis and
variation in biopsy protocols.
Conclusion: The micro-ultrasound training program was effective in improving biopsy quality and rate of csPCa
detection. The presented learning curve provides an initial guide for acquiring expertise with real-time microultrasound
image-guided biopsy.

How to Cite
Cash, H., Hofbauer, S., Shore, N., Pavlovich, C. P., Bulang, S., Schostak, M., Planken, E., Jaspars, J. J., Luger, F., Klotz, L., & Salomon, G. (2022). Prostate Cancer Detection by Novice Micro-Ultrasound Users Enrolled in a Training Program. Société Internationale d’Urologie Journal, 3(2), 62-68.
Original Research