Daniel Junker

Value of Real-Time Elastography Targeted Biopsy for Prostate Cancer Detection in Men With Prostate Specific Antigen 1.25 ng/ml or Greater and 4.00 ng/ml or Less

PURPOSE We assessed the prostate cancer detection rate of real-time elastography targeted biopsy in men with total prostate specific antigen 1.25 ng/ml or greater and 4.00 ng/ml or less. MATERIALS AND METHODS Real-time elastography using an EUB 8500 Hitachi ultrasound system (Hitachi Medical, Tokyo, Japan) was done in 94 men with a mean age of 57.4 years (range 35 to 77) with increased prostate specific antigen between 1.25 ng/ml or greater and 4.00 ng/ml or less (mean 3.20, range 1.30 to 4.00) and a free-to-total prostate specific antigen ratio of less than 18%. Real-time elastography was done to evaluate peripheral zone tissue elasticity and hard areas were defined as suspicious. Targeted biopsies with a maximum of 5 cores were done in suspicious areas, followed by 10-core systematic biopsy. We analyzed the cancer detection rate of real-time elastography and systematic biopsy. RESULTS Cancer was found in 27 of 94 patients (28.7%). Real-time elastography detected cancer in 20 patients (21.3%) and systematic biopsy detected it in 18 (19.1%). Positive cancer cores were found in real-time elastography targeted cores in 38 of 158 cases (24%) and in systematic cores in 38 of 752 (5.1%) (chi-square test p <0.0001). The cancer detection rate per core was 4.7-fold greater for targeted than for systematic biopsy. CONCLUSIONS Real-time elastography targeted biopsy allows prostate cancer detection in men with prostate specific antigen 1.25 ng/ml or greater and 4 ng/ml or less with a decreased number of cores compared with that of systematic biopsy.

Evaluation of the PI-RADS Scoring System for Classifying mpMRI Findings in Men with Suspicion of Prostate Cancer

Purpose. To evaluate the ESUR scoring system (PI-RADS) for multiparametric MRI of the prostate in clinical routine and to define a reliable way to generate an overall PI-RADS score. Methods. Retrospective analysis of all patients with a history of negative prebiopsies, who underwent 3 Tesla multiparametric MRI from October 2011 to April 2013 (n = 143): PI-RADS scores for each single modality were defined. To generate the overall PI-RADS score, an algorithm based approach summing up each single-modality score to a sum-score was compared to a more subjective approach, weighting the single modalities dependent on the radiologists impression. Because of ongoing cancer suspicion 73 patients underwent targeted mpMRI-ultrasound image fusion rebiopsy. For this group thresholds for tumor incidences and malignancy were calculated. Results. 39 (53%) out of 73 targeted rebiopsies were cancer positive. The PI-RADS score correlated well with tumor incidence (AUC of 0.86, 95% CI 0.78 to 0.94) and malignancy (AUC 0.84, 95% CI 0.68 to 0.99). Regarding the sum-score a threshold of ≥10 turned out to be reliable for cancer detection (sensitivity 90%, specificity 62%) and for ≥13 for indicating higher malignancy (Gleason ≥4 + 3) (sensitivity 80%, specificity 86%). To generate the overall PI-RADS score, the use of an algorithm based approach was more reliable than that of the approach based on the radiologists impression. Conclusion. The presented scoring system correlates well with tumor incidence and malignancy. To generate the overall PI-RADS score, it seems to be advisable to use an algorithm based instead of a subjective approach.

Status of Transrectal Ultrasound Imaging of the Prostate

PURPOSE To describe the current and new developments in transrectal ultrasound (US) imaging of the prostate. PATIENTS AND METHODS Grayscale imaging of the prostate is the standard method for diagnostic evaluation and biopsy guidance. Color Doppler (CD) imaging, including CD and power Doppler US, allows for detection of macrovascularity and may therefore be helpful for assessment of prostatic blood flow. The use of US microbubbles for CD imaging and new contrast-specific techniques enable assessment of prostate microvascularity associated with prostate cancer (PCa). Recently, real-time elastography has been introduced to improve detection of cancer based upon changes in tissue stiffness. RESULTS Contrast-enhanced CD imaging has shown to enable PCa detection by performing targeted biopsies into suspicious areas. Comparisons between systematic and contrast-enhanced targeted biopsies have shown that the targeted approach detects more cancers and cancers with higher Gleason scores with a reduced number of biopsy cores. New microbubble-specific US techniques can improve sensitivity and specificity of US imaging for PCa detection. Real-time elastography has been demonstrated to be useful for the detection of PCa, and may further improve PCa staging. CONCLUSIONS The new US techniques seem to have the potential to improve PCa detection, and also PCa grading and staging. As these diagnostic methods improve, the ultimate hope is to eliminate biopsy in patients without cancer.

Comparison of Real-time Sonoelastography With T2-Weighted Endorectal Magnetic Resonance Imaging for Prostate Cancer Detection

The purpose of this study was to compare the value of real‐time sonoelastography with T2‐weighted endorectal magnetic resonance imaging (MRI) for prostate cancer detection.

Comparison of Real-Time Elastography and Multiparametric MRI for Prostate Cancer Detection: A Whole-Mount Step-Section Analysis

OBJECTIVE The purpose of this study was to compare prostate cancer detection rate of real-time elastography (RTE) with that of multiparametric MRI to evaluate the advantages and disadvantages of the two methods. SUBJECTS AND METHODS Thirty-nine patients with biopsy-proven prostate cancer underwent both RTE and multiparametric MRI to localize prostate cancer before radical prostatectomy. RTE was performed to assess prostate tissue elasticity, and hard lesions were considered suspicious for prostate cancer. Multiparametric MRI included T2-weighted MRI, diffusion-weighted MRI (DWI), and contrast-enhanced MRI (CE-MRI) with an endorectal coil at 1.5 T. After radical prostatectomy, whole-mount step sections of the prostate were generated, and the prostate cancer detection rates with both modalities were analyzed for cancer lesions measuring 0.2 cm3 or larger. RESULTS Histopathologic examination revealed 61 cancer lesions. RTE depicted 39 of 50 cancer lesions (78.0%) in the peripheral zone and 2 of 11 (18.2%) in the transitional zone. Multiparametric MRI depicted 45 of 50 cancer lesions (90.0%) in the peripheral zone and 8 of 11 (72.7%) in the transitional zone. Significant differences between the two modalities were found for the transitional zone and anterior part in prostates with volumes greater than 40 cm3 (p<0.05). Detection rates for high-risk prostate cancer (Gleason score≥4 and 3) and cancer lesions with volumes greater than 0.5 cm3 were high for both methods (93.8% and 80.5% for RTE, 87.5% and 92.7% for multiparametric MRI). Volumetric measurements of prostate cancer were more reliable with T2-weighted MRI than with RTE (Spearman rank correlation, 0.72 and 0.46). CONCLUSION RTE and multiparametric MRI depicted high-risk prostate cancer with high sensitivity. However, multiparametric MRI seems to have advantages in tumor volume assessment and for the detection of prostate cancer in the transitional zone and anterior part within prostates larger than 40 cm3.

Multiparametric Magnetic Resonance Imaging/Transrectal Ultrasound Fusion Targeted Biopsy of the Prostate: Preliminary Results of a Prospective Single-Centre Study

Purpose: To evaluate multiparametric magnetic resonance imaging/transrectal ultrasound (mpMRI/TRUS) fusion targeted biopsy (TB) of the prostate for prostate cancer (PCa) diagnosis. Patients and Methods: From April 2013 to January 2014, 53 men were included in this prospective single-centre study. The degree of PCa suspicion from mpMRI findings was classified according to the PI-RADS scoring system. Of these, 50 patients underwent both an mpMRI/TRUS fusion TB and a 10-core systematic biopsy (SB) of the prostate and were eligible for analysis. Results: 225 targeted and 500 systematic cores were included in this study. PCa was histologically confirmed in 52.0% of patients (26/50), whereas TB revealed PCa in 46.0% (23/50) and SB in 36.0% (18/50). TB identified PCa in 16.0% of all patients (8/50) that were missed by SB. All told, the targeted core was 2.8 times more likely to be PCa-positive than the systematic core (29.3 vs. 10.4%). Conclusions: mpMRI/TRUS fusion TB of the prostate is safe, practicable and may improve PCa diagnosis using fewer biopsy cores compared to SB.

Potentials and Limitations of Real-Time Elastography for Prostate Cancer Detection: A Whole-Mount Step Section Analysis

Objectives. To evaluate prostate cancer (PCa) detection rates of real-time elastography (RTE) in dependence of tumor size, tumor volume, localization and histological type. Materials and Methods. Thirdy-nine patients with biopsy proven PCa underwent RTE before radical prostatectomy (RPE) to assess prostate tissue elasticity, and hard lesions were considered suspicious for PCa. After RPE, the prostates were prepared as whole-mount step sections and were compared with imaging findings for analyzing PCa detection rates. Results. RTE detected 6/62 cancer lesions with a maximum diameter of 0–5 mm (9.7%), 10/37 with a maximum diameter of 6–10 mm (27%), 24/34 with a maximum diameter of 11–20 20 mm (70.6%), 14/14 with a maximum diameter of >20 mm (100%) and 40/48 with a volume ≥0.2 cm3 (83.3%). Regarding cancer lesions with a volume ≥ 0.2 cm³ there was a significant difference in PCa detection rates between Gleason scores with predominant Gleason pattern 3 compared to those with predominant Gleason pattern 4 or 5 (75% versus 100%; P = 0.028). Conclusions. RTE is able to detect PCa of significant tumor volume and of predominant Gleason pattern 4 or 5 with high confidence, but is of limited value in the detection of small cancer lesions.

Real-Time Elastography of the Prostate

Palpation of organs is one of the oldest clinical examination techniques, for instance, if you think of the palpation of the breast or the digital rectal examination of the prostate, where hard palpable regions are suspicious for cancer. This is the basic principle of real-time elastography, an ultrasound technique, which is able to visualise tissue elasticity. Since prostate cancer features an increased stiffness due to the higher cell and vessel density than the normal surrounding tissue, real-time elastography has been used for several years for prostate cancer detection. This review introduces the different techniques of ultrasound elastography and furthermore summarises its limitations and potentials.

Multislice computed tomography for preoperative and postoperative assessment in totally endoscopic coronary artery bypass grafting.

This article reviews the clinical value of noninvasive multi-slice computed tomography (MSCT) angiography before and after totally endoscopic coronary artery bypass surgery. The use of coronary and aorto-iliaco-femoral MSCT angiography in the preoperative assessment is addressed and the use of bypass MSCT angiography for postoperative control of bypass graft patency is discussed.

Prostate interdisciplinary communication and mapping algorithm for biopsy and pathology (PIC-MABP) of multiparametric MRI findings

mpMRI findings to predefined regions within the prostate according to a specific division. The urologist then takes biopsy samples of these regions with ultrasound guidance. The reliability of this method depends largely upon the accuracy of the prostate reporting scheme used to assign and communicate mpMRI findings. Therefore, the ESUR guidelines 2012 state that prostates should be divided into at least 16 regions as a minimum requirement [5]. Our experience from interdisciplinary cooperation between radiologists and urologists revealed the need for a prostate reporting scheme, which should be detailed and accurate, yet self-explanatory and easy to memorize. For this purpose, we, together with “TRUST” Training and Research in Urological Surgery and Technology, developed a ‘Prostate interdisciplinary communication and mapping algorithm for biopsy and pathology’ (PIC-MABP). PIC-MABP provides a prostate map derived from the division of a clock face, which is aligned to the orientation of histopathological whole-mount step sections. The pattern of a clock face offers the advantages to be both detailed and intuitive. Considering variations of normal prostate anatomy, PIC-MABP was designed to work independently of anatomical structures.