The role of elastography in improving detection rates of prostate cancer

Objectives: In this study we sought to evaluate whether elastography targeted biopsy improves the detection rate of PCa (prostate cancer) compared to systematic biopsy guided by conventional grayscale ultrasound (GSU). Materials and method: We conducted a prospective study and enrolled 240 patients on which we performed a 12 core prostate biopsy by conventional ultrasound guidence or elastography guided. The external prostate was divided into six sectors: base right, middle right, apex right, baseleft, middle left, apex left. These sectors were scanned for suspicious lesions by elastography – hard areas - and by gray scale ultrasound - hipoechoic areas. If in a certain sector a suspicious area was found, regardless of the imaging method, a single biopsy from this area was performed , whilst considering it representative for that certain sector. Imaging results were correlated with the results received from the pathologist lab. The two tools used in prostate biopsy guidance were compared statistically in terms of the detection rate of prostate cancer. We did not find statistical differences between the two groups concerning age, PSA (prostatic specific antigen), prostate volume, the data obtained by digital rectal examination. Prostate cancer was detected in 42.5% of patients (102 of 240). PCa detection rate was significantly higher in those who used elastography 51.6% (62 of 120) compared to those that have used conventional ultrasound 38.3% (46 of 120). elastography’ssensitivity was 56.8% compared to 17.5% for conventional ultrasound. Specificity was 70.7% compared to 92.8% for elastography to conventional ultrasound. Conclusions: Using elastography in prostate biopsy has higher sensitivity than using conventional ultrasound. But the overall sensitivity obtained has not reached levels that allow omitting the randomized systematic biopsy.