OBJECTIVE: To evaluate the performance of real-time elastography (RTE) in an initial biopsy setting.
MATERIAL AND METHODS: In the period from February 2011 to June 2012, 127 consecutive patients were included in the study. We used a Hitachi Preirus with Hi-RTE module, a prostate end-fire transrectal probe was used for RTE and for targeted biopsies, a simultaneous biplane probe was used for the standard systematic biopsies. The peripheral zone of the prostate was divided into six regions, and each biopsy obtained was referred to a specific region. All patients were first examined with RTE and, if cancer was suspected, targeted biopsies were taken. A standard systematic 10-core biopsy was then performed in all patients.
RESULTS: A total of 64 (50%) patients were diagnosed with prostate cancer (PC) in the initial biopsy setting. Three patients were diagnosed solely on RTE targeted biopsies, 31 were found only in systematic biopsies, and 30 were correctly diagnosed with both methods. In the RTE positive group there was a significantly higher frequency of positive cores, a lower prostate volume, a higher Gleason score, and a higher fraction of cancer tissue in each core. In a multiple regression model RTE came out as an independent marker for high-risk cancer. The sensitivity of 42% for all PCs increased to 60% for high-grade PCs. Similarly, the negative predictive value increased from 79% to 97%. An additional 8 patients were diagnosed with PC during the study period.
CONCLUSIONS: A positive RTE is an independent marker for detection of high-risk prostate cancer, and a negative RTE argue against such. RTE with targeted biopsies cannot replace systematic biopsies, but provides valuable additional information about the tumours.
Written by:
Nygård Y, Haukaas SA, Halvorsen OJ, Gravdal K, Frugård J, Akslen LA, Beisland C. Are you the author?
Department of Urology, Haukeland University Hospital.
Reference: BJU Int. 2013 Aug 12. Epub ahead of print.
doi: 10.1111/bju.12401
PubMed Abstract
PMID: 24053494
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