T. Eggert

The Impact of Real-Time Elastography Guiding a Systematic Prostate Biopsy to Improve Cancer Detection Rate: A Prospective Study of 353 Patients

PURPOSE We evaluated whether real-time elastography guided biopsy improves prostate cancer detection compared to conventional systematic gray scale ultrasound guidance. MATERIALS AND METHODS A total of 353 consecutive patients suspicious for prostate cancer were prospectively randomized for real-time elastography (178) or gray scale ultrasound (175). Each patient enrolled in the study underwent a 10-core prostate biopsy. Six lateral prostate sectors (base, mid, apex) were scanned for cancer suspicious areas, defined as stiffer blue lesions using real-time elastography and hypoechoic lesions using gray scale ultrasound. Suspicious areas were sampled by a single targeted biopsy and considered representative of a defined prostate sector. If real-time elastography or gray scale ultrasound did not visualize a suspicious area in a sector, the biopsy core was taken systematically. Imaging findings were correlated with histopathological reports. Real-time elastography and gray scale ultrasound cases were compared in terms of cancer detection rate and imaging guidance accuracy. RESULTS Characteristics of patients undergoing real-time elastography and gray scale ultrasound, including age, prostate specific antigen, prostate volume and digital rectal examination, were not significantly different (p>0.05). Prostate cancer was detected in 160 of 353 patients (45.3%). The prostate cancer detection rate was significantly higher in patients who underwent biopsy with the real-time elastography guided approach compared to the gray scale ultrasound guided biopsy at 51.1% (91 of 178) vs 39.4% (69 of 175) (p=0.027). Overall sensitivity and specificity to detect prostate cancer was 60.8% and 68.4% for real-time elastography vs 15% and 92.3% for gray scale ultrasound, respectively. CONCLUSIONS Sensitivity to visualize and detect prostate cancer improved using real-time elastography in addition to gray scale ultrasound during prostate biopsy. Overall sensitivity did not reach levels to omit a systematic biopsy approach.

Multiparametric ultrasound of the prostate: adding contrast enhanced ultrasound to real-time elastography to detect histopathologically confirmed cancer.

PURPOSE We prospectively assessed whether a combined approach of real-time elastography and contrast enhanced ultrasound would improve prostate cancer visualization. MATERIAL AND METHODS Between June 2011 and January 2012, 100 patients with biopsy proven prostate cancer underwent preoperative transrectal multiparametric ultrasound combining real-time elastography and contrast enhanced ultrasound. After initial elastographic screening for suspicious lesions, defined as blue areas with decreased tissue strain, each lesion was allocated to the corresponding prostate sector. The target lesion was defined as the largest cancer suspicious area. Perfusion was monitored after intravenous injection of contrast agent. Target lesions were examined for hypoperfusion, normoperfusion or hyperperfusion. Imaging results were correlated with final pathological evaluation on whole mount slides after radical prostatectomy. RESULTS Of 100 patients 86 were eligible for final analysis. Real-time elastography detected prostate cancer with 49% sensitivity and 73.6% specificity. Histopathology confirmed malignancy in 56 of the 86 target lesions (65.1%). Of these 56 lesions 52 (92.9%) showed suspicious perfusion, including hypoperfusion in 48.2% and hyperperfusion in 48.2%, while only 4 (7.1%) showed normal perfusion patterns (p = 0.001). The multiparametric approach decreased the false-positive value of real-time elastography alone from 34.9% to 10.3% and improved the positive predictive value of cancer detection from 65.1% to 89.7%. CONCLUSIONS Perfusion patterns of prostate cancer suspicious elastographic lesions are heterogeneous. However, the combined approach of real-time elastography and contrast enhanced ultrasound in this pilot study significantly decreased false-positive results and improved the positive predictive value of correctly identifying histopathological cancer.

[Impact of elastography in clinical diagnosis of prostate cancer. A comparison of cancer detection between B-mode sonography and elastography-guided 10-core biopsies].

BACKGROUND To assess whether elastography guided prostate biopsies improve the cancer detection in men with suspected prostate cancer. PATIENTS AND METHODS In this study, 351 prospectively randomized patients underwent prostate biopsies for the first time. The indication for biopsy was abnormal digital rectal examination (DRE) in 25% or suspicious prostate-specific antigen (PSA) elevation in 75%. In the elastography group (n=189) and the control group (n=162), we assessed PSA, DRE, and B-mode transrectal ultrasound (TRUS). Both groups underwent classic TRUS-guided 10-core biopsy. The elastography patients underwent additional elastographic examination prior to biopsy using a Voluson 730 ultrasound system (GE Medical). According to the ultrasound or elastographic findings for each biopsy location, the researcher tried to predict whether cancer was present. This prediction was correlated with histopathologic findings. The statistical power of this study was sufficient to detect a 15% difference in detection rate. RESULTS The study groups did not differ in PSA, clinical stages, or prostate volume (p<0.05). The overall cancer detection rate was 39% (137/351): 40.2% (76/189) in the elastography group and 37.7% (61/189) in the control group, respectively. The difference in detection rate in clinical stages T2 and T3 between the elastography and the control groups was not statistically significant (p<0.05). Within the T1c subgroup, elastography showed a slightly higher detection rate of 55.6% versus 50% without reaching statistical significance (p>0.05). Histopathologic findings were adequately predicted by elastography in only 44.5%. CONCLUSIONS Elastography did not improve the cancer detection rate in our collective.

Stellenwert der Elastographie in der klinischen Diagnostik des lokalisierten Prostatakarzinoms

BACKGROUND To assess whether elastography guided prostate biopsies improve the cancer detection in men with suspected prostate cancer. PATIENTS AND METHODS In this study, 351 prospectively randomized patients underwent prostate biopsies for the first time. The indication for biopsy was abnormal digital rectal examination (DRE) in 25% or suspicious prostate-specific antigen (PSA) elevation in 75%. In the elastography group (n=189) and the control group (n=162), we assessed PSA, DRE, and B-mode transrectal ultrasound (TRUS). Both groups underwent classic TRUS-guided 10-core biopsy. The elastography patients underwent additional elastographic examination prior to biopsy using a Voluson 730 ultrasound system (GE Medical). According to the ultrasound or elastographic findings for each biopsy location, the researcher tried to predict whether cancer was present. This prediction was correlated with histopathologic findings. The statistical power of this study was sufficient to detect a 15% difference in detection rate. RESULTS The study groups did not differ in PSA, clinical stages, or prostate volume (p<0.05). The overall cancer detection rate was 39% (137/351): 40.2% (76/189) in the elastography group and 37.7% (61/189) in the control group, respectively. The difference in detection rate in clinical stages T2 and T3 between the elastography and the control groups was not statistically significant (p<0.05). Within the T1c subgroup, elastography showed a slightly higher detection rate of 55.6% versus 50% without reaching statistical significance (p>0.05). Histopathologic findings were adequately predicted by elastography in only 44.5%. CONCLUSIONS Elastography did not improve the cancer detection rate in our collective.

Comprehensive report on prostate cancer misclassification by 16 currently used low-risk and active surveillance criteria.

Study Type – Prognosis (case series)

Assessing the vesico-urethral anastomosis after radical retropubic prostatectomy: transrectal ultrasonography can replace cystography

To determine if transrectal ultrasonography (TRUS) is as reliable as cystography in detecting vesico‐urethral extravasation (VE) after radical retropubic prostatectomy (RRP).

Rising PSA level and negative prostate biopsy. Can prostate elastography help

ZusammenfassungBisherige Studien haben den klinischen Nutzen der Elastographie beim Staging vor radikaler Prostatektomie und als zusätzliche Bildinformation mit dem Ziel einer verbesserten Karzinomdetektion bei der Prostatabiopsie untersucht. Der rasche Fortschritt dieser Technik hat zu einer spürbaren Erleichterung der Befunderhebung und deren Reproduzierbarkeit geführt. In neueren Gerätegenerationen spiegelt sich dies bereits in ersten Studienergebnissen wieder. Um den Stellenwert dieses Verfahrens im klinischen Alltag zu bestimmen sind weitere Studien erforderlich, welche einerseits elastographiegesteuerte Biopsieschemata mit Sättigungsbiopsien und andererseits die Sensitivität und Spezifität der elastographischen Prostatakarzinomdetektion mit denen anderer bildgebender Verfahren, insbesondere der Magnetresonanztomographie und -spektroskopie, vergleichen.AbstractPrevious studies investigated the clinical impact of elastography for preoperative staging and as an additional imaging modality to improve prostate cancer detection during prostate biopsy. This rapidly improving technique has facilitated progress toward feasibility and reproducibility of transrectal elastography. Recent studies show significant improvements using the latest generation of elastographic devices. Further studies are needed to evaluate on the one hand elastography-guided prostate biopsy schemes and results of saturation biopsies and on the other hand to compare sensitivity and specificity of elastographic detection of prostate cancer with different imaging techniques, especially magnetic resonance imaging and spectroscopy.Previous studies investigated the clinical impact of elastography for preoperative staging and as an additional imaging modality to improve prostate cancer detection during prostate biopsy. This rapidly improving technique has facilitated progress toward feasibility and reproducibility of transrectal elastography. Recent studies show significant improvements using the latest generation of elastographic devices. Further studies are needed to evaluate on the one hand elastography-guided prostate biopsy schemes and results of saturation biopsies and on the other hand to compare sensitivity and specificity of elastographic detection of prostate cancer with different imaging techniques, especially magnetic resonance imaging and spectroscopy.

Steigender PSA-Wert und negative Prostatabiopsie

ZusammenfassungBisherige Studien haben den klinischen Nutzen der Elastographie beim Staging vor radikaler Prostatektomie und als zusätzliche Bildinformation mit dem Ziel einer verbesserten Karzinomdetektion bei der Prostatabiopsie untersucht. Der rasche Fortschritt dieser Technik hat zu einer spürbaren Erleichterung der Befunderhebung und deren Reproduzierbarkeit geführt. In neueren Gerätegenerationen spiegelt sich dies bereits in ersten Studienergebnissen wieder. Um den Stellenwert dieses Verfahrens im klinischen Alltag zu bestimmen sind weitere Studien erforderlich, welche einerseits elastographiegesteuerte Biopsieschemata mit Sättigungsbiopsien und andererseits die Sensitivität und Spezifität der elastographischen Prostatakarzinomdetektion mit denen anderer bildgebender Verfahren, insbesondere der Magnetresonanztomographie und -spektroskopie, vergleichen.AbstractPrevious studies investigated the clinical impact of elastography for preoperative staging and as an additional imaging modality to improve prostate cancer detection during prostate biopsy. This rapidly improving technique has facilitated progress toward feasibility and reproducibility of transrectal elastography. Recent studies show significant improvements using the latest generation of elastographic devices. Further studies are needed to evaluate on the one hand elastography-guided prostate biopsy schemes and results of saturation biopsies and on the other hand to compare sensitivity and specificity of elastographic detection of prostate cancer with different imaging techniques, especially magnetic resonance imaging and spectroscopy.Previous studies investigated the clinical impact of elastography for preoperative staging and as an additional imaging modality to improve prostate cancer detection during prostate biopsy. This rapidly improving technique has facilitated progress toward feasibility and reproducibility of transrectal elastography. Recent studies show significant improvements using the latest generation of elastographic devices. Further studies are needed to evaluate on the one hand elastography-guided prostate biopsy schemes and results of saturation biopsies and on the other hand to compare sensitivity and specificity of elastographic detection of prostate cancer with different imaging techniques, especially magnetic resonance imaging and spectroscopy.

Steigender PSA-Wert und negative Prostatabiopsie@@@Rising PSA level and negative prostate biopsy: Kann die Prostataelastographie helfen?@@@Can prostate elastography help?

ZusammenfassungBisherige Studien haben den klinischen Nutzen der Elastographie beim Staging vor radikaler Prostatektomie und als zusätzliche Bildinformation mit dem Ziel einer verbesserten Karzinomdetektion bei der Prostatabiopsie untersucht. Der rasche Fortschritt dieser Technik hat zu einer spürbaren Erleichterung der Befunderhebung und deren Reproduzierbarkeit geführt. In neueren Gerätegenerationen spiegelt sich dies bereits in ersten Studienergebnissen wieder. Um den Stellenwert dieses Verfahrens im klinischen Alltag zu bestimmen sind weitere Studien erforderlich, welche einerseits elastographiegesteuerte Biopsieschemata mit Sättigungsbiopsien und andererseits die Sensitivität und Spezifität der elastographischen Prostatakarzinomdetektion mit denen anderer bildgebender Verfahren, insbesondere der Magnetresonanztomographie und -spektroskopie, vergleichen.AbstractPrevious studies investigated the clinical impact of elastography for preoperative staging and as an additional imaging modality to improve prostate cancer detection during prostate biopsy. This rapidly improving technique has facilitated progress toward feasibility and reproducibility of transrectal elastography. Recent studies show significant improvements using the latest generation of elastographic devices. Further studies are needed to evaluate on the one hand elastography-guided prostate biopsy schemes and results of saturation biopsies and on the other hand to compare sensitivity and specificity of elastographic detection of prostate cancer with different imaging techniques, especially magnetic resonance imaging and spectroscopy.Previous studies investigated the clinical impact of elastography for preoperative staging and as an additional imaging modality to improve prostate cancer detection during prostate biopsy. This rapidly improving technique has facilitated progress toward feasibility and reproducibility of transrectal elastography. Recent studies show significant improvements using the latest generation of elastographic devices. Further studies are needed to evaluate on the one hand elastography-guided prostate biopsy schemes and results of saturation biopsies and on the other hand to compare sensitivity and specificity of elastographic detection of prostate cancer with different imaging techniques, especially magnetic resonance imaging and spectroscopy.

Stellenwert der Elastographie in der klinischen Diagnostik des lokalisierten Prostatakarzinoms@@@Impact of elastography in clinical diagnosis of prostate cancer: Vergleich von Detektionsraten der B-Modus-Sonographie und der elastographieunterstützten systematischen 10fach-Biopsie@@@A comparison of cancer detection between B-mode sonography and elastography-guided 10-core biopsies

BACKGROUND To assess whether elastography guided prostate biopsies improve the cancer detection in men with suspected prostate cancer. PATIENTS AND METHODS In this study, 351 prospectively randomized patients underwent prostate biopsies for the first time. The indication for biopsy was abnormal digital rectal examination (DRE) in 25% or suspicious prostate-specific antigen (PSA) elevation in 75%. In the elastography group (n=189) and the control group (n=162), we assessed PSA, DRE, and B-mode transrectal ultrasound (TRUS). Both groups underwent classic TRUS-guided 10-core biopsy. The elastography patients underwent additional elastographic examination prior to biopsy using a Voluson 730 ultrasound system (GE Medical). According to the ultrasound or elastographic findings for each biopsy location, the researcher tried to predict whether cancer was present. This prediction was correlated with histopathologic findings. The statistical power of this study was sufficient to detect a 15% difference in detection rate. RESULTS The study groups did not differ in PSA, clinical stages, or prostate volume (p<0.05). The overall cancer detection rate was 39% (137/351): 40.2% (76/189) in the elastography group and 37.7% (61/189) in the control group, respectively. The difference in detection rate in clinical stages T2 and T3 between the elastography and the control groups was not statistically significant (p<0.05). Within the T1c subgroup, elastography showed a slightly higher detection rate of 55.6% versus 50% without reaching statistical significance (p>0.05). Histopathologic findings were adequately predicted by elastography in only 44.5%. CONCLUSIONS Elastography did not improve the cancer detection rate in our collective.