Early prostate cancer detection: Targeted biopsy based on findings from SonoElastography and endorectal MRI

Objective: To assess the value of SonoElastography for detection of early prostate cancer in comparison to endorectal MRI.

Materials and methods: Fifty patients with elevated PSA blood values (ranging from 1.5 to 6.0) were examined with endorectal SonoElastography (Examiner 1; Hitachi), during which the elasticity of prostate tissue was displayed from red (soft) to blue (hard). Hard lesions were considered as malignant. The findings of SonoElastography were compared with T2w and contrast enhanced T1w endorectal MRI images (Examiner 2; Siemens, 1.5T). Suspicious areas were divided in 3 groups. Group A: tissue changes in both methods, Group B: changes in SonoElastography alone, Group C: changes in MRI alone. All these areas were selected for US guided targeted prostate biopsy with 2 cores from each lesion. Subsequently systematic biopsy was performed.

Results: Overall 87 areas (174 cores) were selected in Group A, 24 in Group B (48 cores), and 14 in Group C (28 cores) for targeted biopsy. Targeted biopsy detected cancer in 18/50 patients (Gleason 5–7), whereas the systematic biopsy detected cancer in 14 patients. In Group A 32 cores (18%) were postive for cancer, in Group B 6 cores (13%), in Group C 4 cores (12%) and in the systematic biopsy 31/500 cores (6%).

Conclusion: With the limitation of a small study population SonoElastography combined with MRI seems to be able to enhance visualization of early prostate cancer.