A positive real-time elastography is an independent marker for detection of high-risk prostate cancers in the primary biopsy setting.
OBJECTIVE
To evaluate the performance of real-time elastography (RTE) in an initial biopsy setting.


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, and 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 taken in all patients.


RESULTS
In all, 64 (50%) patients were diagnosed with prostate cancer 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 was an independent marker for high-risk cancer. The sensitivity of 42% for all prostate cancers increased to 60% for high-grade prostate cancers. Similarly, the negative predictive value increased from 79% to 97%. An additional eight patients were diagnosed with prostate cancer during the study period.


CONCLUSIONS
A positive RTE is an independent marker for detection of high-risk prostate cancer, and a negative RTE argues against such. RTE with targeted biopsies cannot replace systematic biopsies, but provides valuable additional information about the tumours.
Department of Urology, Haukeland University Hospital, Bergen, Norway.
Yngve
Y
Nygård
Svein A
SA
Haukaas
Ole J
OJ
Halvorsen
Karsten
K
Gravdal
Jannicke
J
Frugård
Lars A
LA
Akslen
Christian
C
Beisland
D000328:Adult; D000368:Aged; D001706:Biopsy; D003199:Computer Systems; D054459:Elasticity Imaging Techniques; D006801:Humans; D061705:Image-Guided Biopsy; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D018570:Risk Assessment
diagnosis; high-risk cancers; prostate biopsy; prostate cancer; real-time elastography; treatment