Prostate Cancer Ultrasound: Is Still a Valid Tool?

The main purpose of this paper review is to highlight the latest ultrasound (US) imaging technologies of the prostate gland, an organ increasingly at the center of attention in the field of oncological diseases of the male sex, which needs a 360° evaluation in order to obtain tailored therapeutic planning. Specialist urological evaluation is designated for this purpose, together with integrated prostate imaging which currently tends to focus more and more on the use of US imaging and its state-of-the-art technologies in iconographic diagnosis, biopsy and, sometimes, treatment of prostatic cancer. In particular, the main tools to which reference is made, represent a valid aid to basic US technologies already widely known and diffused, like the grayscale US or the Doppler US, for a "multiparametric" evaluation of the prostate cancer. The concept of multiparametricity is explained by the integration of prostate imaging obtained both with the US evaluation of the gland before and after administration of contrast medium, with the elaboration of parametric maps of quantitative measurement of the enhancement, and with elastography that provides information about the tissue consistency, a finding that strongly relates with the degree of cellularity and with the tumor grading. Prostate cancer screening consists of dosing serum levels of prostate-specific antigen (PSA) and performing digit-rectal examination (DRE), more or less associated with transrectal prostate ultrasound (TRUS). However, although these are the most common techniques in clinical practice, they have numerous limitations and make the diagnosis of prostate cancer often challenging. The purpose of mp-US is to enrich the clinical-laboratory data and, above all, the standard US imaging with further details to strengthen the suspicion of malignancy of a prostate tumor, which needs to be addressed to diagnostic deepening with biopsy. This review article provides a summary of the current evidence on mp-US imaging in the evaluation of a clinically significant prostate cancer, comparing the data obtained to the imaging of mp-MRI, the reference tool both in diagnosis and staging.