Micro‐ultrasound tissue echogenicity predicts prostate cancer grade

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Main Authors: Ailene E. Corona, Dan Luca, Kian Kolahi Sohrabi, Kyla Grunden, William Chen, Pooneh J. Sarmadian, Kevin J. Walsh, Lorna Kwan, Qi Miao, Kyung Sung, Wayne G. Brisbane
Format: Artículo Open Access
Published: Wiley 2026
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author Ailene E. Corona
Dan Luca
Kian Kolahi Sohrabi
Kyla Grunden
William Chen
Pooneh J. Sarmadian
Kevin J. Walsh
Lorna Kwan
Qi Miao
Kyung Sung
Wayne G. Brisbane
author_facet Ailene E. Corona
Dan Luca
Kian Kolahi Sohrabi
Kyla Grunden
William Chen
Pooneh J. Sarmadian
Kevin J. Walsh
Lorna Kwan
Qi Miao
Kyung Sung
Wayne G. Brisbane
Ailene E. Corona
Dan Luca
Kian Kolahi Sohrabi
Kyla Grunden
William Chen
Pooneh J. Sarmadian
Kevin J. Walsh
Lorna Kwan
Qi Miao
Kyung Sung
Wayne G. Brisbane
collection Wiley Open Access
contents Micro‐ultrasound tissue echogenicity predicts prostate cancer grade Ailene E. Corona Dan Luca Kian Kolahi Sohrabi Kyla Grunden William Chen Pooneh J. Sarmadian Kevin J. Walsh Lorna Kwan Qi Miao Kyung Sung Wayne G. Brisbane BJUI Compass Abstract Objectives This study aimed to evaluate the association between lesion echogenicity on micro‐ultrasound (micro‐US) and the presence and grade of prostate cancer. Patients and Methods We prospectively analysed 229 prostate lesions from 181 men undergoing micro‐US‐guided transperineal biopsy at UCLA. Lesions were visually graded as hyperechoic, isoechoic or hypoechoic relative to the central zone, which served as an internal reference due to its consistent tissue characteristics and low malignancy risk. Biopsy targeting was confirmed by visualizing the needle tract within the lesion. The primary outcome was the detection rate of Grade Group (GG) ≥ 2 cancer across echogenicity categories. Secondary analyses included associations with PSA density and MRI‐derived apparent diffusion coefficient (ADC) values, given that ADC is associated with tissue cellularity. Statistical comparisons were performed using chi‐square and Kruskal–Wallis tests, with post hoc pairwise analyses where appropriate. Results GG ≥ 2 cancer detection rates increased with decreasing echogenicity: 22% in hyperechoic, 56.2% in isoechoic and 62.4% in hypoechoic lesions ( p  < 0.01). Hypoechoic lesions also exhibited a higher proportion of GG ≥ 3 cancers ( p  < 0.05). ADC values declined progressively from hyperechoic to hypoechoic lesions (median: 980, 851 and 751, respectively; p  < 0.01), suggesting higher tissue cellularity. Regression analysis demonstrated no meaningful interaction between PRI‐MUS and echogenicity. PSA density did not significantly differ among echogenicity groups. Conclusions Lesion hypoechogenicity on micro‐US is strongly associated with higher grade prostate cancer and lower ADC values, suggesting a link to tissue cellularity. These findings support the incorporation of echogenicity as a diagnostic marker within the micro‐US PRI‐MUS framework, potentially enhancing the accuracy of prostate cancer risk stratification. 10.1002/bco2.70192 http://creativecommons.org/licenses/by/4.0/
doi_str_mv 10.1002/bco2.70192
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institution Wiley Open Access
license_str_mv http://creativecommons.org/licenses/by/4.0/
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publisher Wiley
record_format wiley_oa
spellingShingle Micro‐ultrasound tissue echogenicity predicts prostate cancer grade
Ailene E. Corona
Dan Luca
Kian Kolahi Sohrabi
Kyla Grunden
William Chen
Pooneh J. Sarmadian
Kevin J. Walsh
Lorna Kwan
Qi Miao
Kyung Sung
Wayne G. Brisbane
BJUI Compass
Micro‐ultrasound tissue echogenicity predicts prostate cancer grade Ailene E. Corona Dan Luca Kian Kolahi Sohrabi Kyla Grunden William Chen Pooneh J. Sarmadian Kevin J. Walsh Lorna Kwan Qi Miao Kyung Sung Wayne G. Brisbane BJUI Compass Abstract Objectives This study aimed to evaluate the association between lesion echogenicity on micro‐ultrasound (micro‐US) and the presence and grade of prostate cancer. Patients and Methods We prospectively analysed 229 prostate lesions from 181 men undergoing micro‐US‐guided transperineal biopsy at UCLA. Lesions were visually graded as hyperechoic, isoechoic or hypoechoic relative to the central zone, which served as an internal reference due to its consistent tissue characteristics and low malignancy risk. Biopsy targeting was confirmed by visualizing the needle tract within the lesion. The primary outcome was the detection rate of Grade Group (GG) ≥ 2 cancer across echogenicity categories. Secondary analyses included associations with PSA density and MRI‐derived apparent diffusion coefficient (ADC) values, given that ADC is associated with tissue cellularity. Statistical comparisons were performed using chi‐square and Kruskal–Wallis tests, with post hoc pairwise analyses where appropriate. Results GG ≥ 2 cancer detection rates increased with decreasing echogenicity: 22% in hyperechoic, 56.2% in isoechoic and 62.4% in hypoechoic lesions ( p  < 0.01). Hypoechoic lesions also exhibited a higher proportion of GG ≥ 3 cancers ( p  < 0.05). ADC values declined progressively from hyperechoic to hypoechoic lesions (median: 980, 851 and 751, respectively; p  < 0.01), suggesting higher tissue cellularity. Regression analysis demonstrated no meaningful interaction between PRI‐MUS and echogenicity. PSA density did not significantly differ among echogenicity groups. Conclusions Lesion hypoechogenicity on micro‐US is strongly associated with higher grade prostate cancer and lower ADC values, suggesting a link to tissue cellularity. These findings support the incorporation of echogenicity as a diagnostic marker within the micro‐US PRI‐MUS framework, potentially enhancing the accuracy of prostate cancer risk stratification. 10.1002/bco2.70192 http://creativecommons.org/licenses/by/4.0/
title Micro‐ultrasound tissue echogenicity predicts prostate cancer grade
topic BJUI Compass
url https://bjui-journals.onlinelibrary.wiley.com/doi/10.1002/bco2.70192