title: Computer-aided transrectal ultrasound: does prostate HistoScanning™ improve detection performance of prostate cancer in repeat biopsies?
abstract: BACKGROUND
  An imaging tool providing reliable prostate cancer (PCa) detection and localization is necessary to improve common diagnostic pathway with ultrasound targeted biopsies. To determine the performance of transrectal ultrasound (TRUS) augmented by prostate HistoScanning(TM) analysis (PHS) we investigated the detection of prostate cancer (PCa) foci in repeat prostate biopsies (Bx).
  
  
  METHODS
  97 men with a mean age of 66.2 (44-82) years underwent PHS augmented TRUS analysis prior to a repeat Bx. Three PHS positive foci were defined in accordance with 6 bilateral prostatic sectors. Targeted Bx (tBx) limited to PHS positive foci and a systematic 14-core backup Bx (sBx) were taken. Results were correlated to biopsy outcome. Sensitivity, specificity, predictive accuracy, negative predictive value (NPV) and positive predictive value (PPV) were calculated.
  
  
  RESULTS
  PCa was found in 31 of 97 (32%) patients. Detection rate in tBx was significantly higher (p < .001). Detection rate in tBx and sBx did not differ on patient level (p ≥ 0.7). PHS sensitivity, specificity, predictive accuracy, PPV and NPV were 45%, 83%, 80%, 19% and 95%, respectively.
  
  
  CONCLUSIONS
  PHS augmented TRUS identifies abnormal prostatic tissue. Although sensitivity and PPV for PCa are low, PHS information facilitates Bx targeting to vulnerable foci and results in a higher cancer detection rate. PHS targeted Bx should be considered in patients at persistent risk of PCa.
authors.affiliation: Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Arnold Heller Str. 3, 24105, Kiel, Germany. moritz.hamann@uksh.de.
authors.forename: Moritz Franz
authors.initials: MF
authors.lastname: Hamann
authors.affiliation: Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Arnold Heller Str. 3, 24105, Kiel, Germany. claudiushamann@googlemail.com.
authors.forename: C
authors.initials: C
authors.lastname: Hamann
authors.affiliation: Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Arnold Heller Str. 3, 24105, Kiel, Germany. atrettel@yahoo.com.
authors.forename: A
authors.initials: A
authors.lastname: Trettel
authors.affiliation: Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Arnold Heller Str. 3, 24105, Kiel, Germany. Klaus-Peter.Juenemann@uksh.de.
authors.forename: K P
authors.initials: KP
authors.lastname: Jünemann
authors.affiliation: Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Arnold Heller Str. 3, 24105, Kiel, Germany. CarstenMaik.Naumann@uksh.de.
authors.forename: C M
authors.initials: CM
authors.lastname: Naumann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*