Micro-ultrasound experience and clinically significant prostate cancer detection: a center-level analysis of the optimum randomized trial
In brief
Micro-ultrasound experience did not improve prostate cancer detection in OPTIMUM
In the OPTIMUM trial analysis, adding center-level measures of operator experience did not improve models' ability to identify clinically significant prostate cancer; both models had an area under the curve of 0.803. All participating operators met a proficiency threshold, so the findings suggest limited learning-curve effects in this setting, not that experience is irrelevant for less-trained operators.
- Journal
- Prostate cancer and prostatic diseases (Q1)
- Published
- 28 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Melis Guer, Alon Lazarovich, Ferdinand Luger, Hannes Cash, Sangeet Ghai, L Felipe Urdaneta-Salegui, et al.
- PMID
- 42957822
- DOI
- 10.1038/s41391-026-01171-y
Why clinicians should know about it
- Picked for Urology (top studies of the week, 1 November 2026): Randomized-trial analysis informs micro-ultrasound prostate biopsy detection
Abstract
BACKGROUND: Micro-ultrasound real-time imaging technology is increasingly performed for prostate biopsy. While a learning curve is expected, the effect of operator experience on clinically significant prostate cancer (csPCa) detection has not been clearly defined. METHODS: We analyzed data from the multicenter randomized OPTIMUM trial utilizing two logistic regression models to predict csPCa. Center-level experience was represented by two standardized measures derived from operator-level data: Center Case Load Score and Center Mastery Score. Model 1 included the Center Mastery Score and Center Case Volume; Model 2 excluded them. Performance was assessed using confusion matrices and the area under the curve (AUC). RESULTS: Experience proxies did not improve discrimination for csPCa detection. Sensitivity/specificity/AUC were 0.851/0.523/0.803 vs 0.851/0.544/0.803 for Models 1 and 2, respectively. In Model 1, experience proxies were not significant predictors; csPCa was significantly associated with increasing age (p < 0.001), higher PSA (p < 0.001), smaller prostate volume (p < 0.001), suspicious DRE (p = 0.001). Low PRI-MUS Score (1-2) was associated with decreased risk of csPCa (p = 0.001). Operator heterogeneity and potential bias in experience proxies remain limitations. CONCLUSION: Ensuring Level 3 proficiency among all participating operators and incorporating experience proxies with clinical risk factors and PRI-MUS score, center-level experience was not associated with csPCa detection. Our results reflect the successful integration of proficiency standards in clinical practice, while minimizing learning curve effects, and suggest that the required proficiency threshold was an effective proxy for mastery of microUS.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.