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A positive real‐time elastography is an independent marker for detection of high‐risk prostate cancers in the primary biopsy setting
Author(s) -
Nygård Yngve,
Haukaas Svein A.,
Halvorsen Ole J.,
Gravdal Karsten,
Frugård Jannicke,
Akslen Lars A.,
Beisland Christian
Publication year - 2014
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12401
Subject(s) - medicine , prostate cancer , biopsy , prostate , elastography , prostate biopsy , radiology , cancer , urology , oncology , ultrasound
Objective To evaluate the performance of real‐time elastography ( RTE ) in an initial biopsy setting.Patients and Methods In the period from F ebruary 2011 to J une 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.