Prediction of Significant Prostate Cancer at Prostate Biopsy and Per Core Detection Rate of Targeted and Systematic Biopsies Using Real-Time Shear Wave Elastography

Abstract

Introduction: Prostate cancer (PCa) detection is accompanied by overdiagnosis and mischaracterization of PCa. Therefore, new imaging modalities like shear wave elastography (SWE) are required. Aim: The aim of this study was to evaluate per-core detection rates (DRs) of targeted biopsies and systematic biopsies and to test if SWE findings can predict presence of clinically significant PCa (csPCa) at biopsy. Patients and Methods: Overall, 95 patients scheduled for prostate biopsy in our center underwent SWE. SWE findings were classified into suspicious or normal. Targeted biopsies were taken in up to 3 SWE-suspicious areas. csPCa was defined as the presence of Gleason pattern ≥4, level of prostate-specific antigen ≥10 ng/ml or >2 positive cores. Results: Overall DR for csPCa in our study cohort was 40%. Per-core DR for exclusively SWE-targeted cores versus systematic samples cores was 10.5 vs. 8.6% (p = 0.3). In the logistic regression models, individuals with suspicious SWE findings are at 6.4-fold higher risk of harboring csPCa (p = 0.03). Gain in predictive accuracy was 2.3% (0.82 vs. 0.84, p = 0.01). Conclusions: Presence of suspicious SWE findings is an independent predictor of csPCa. Therefore, SWE may be helpful in selecting patients for biopsy. Nonetheless, per-core DR for SWE-targeted cores was not statistically significant higher than DR of systematic sampled cores. Therefore, additional systematic biopsy is mandatory.

Shear Wave Elastography (SWE) for the Evaluation of Patients with Tendinopathies

“…Real-time ultra-fast SWE measures shear wave velocity (in meters per second) generated by the US pulse (7). SWE has been used to evaluate liver stiffness and stiffness of breast (13,14), prostate (15,16), and thyroid lesions (17). SWE seems to increase specificity and positive predictive value in the assessment of breast (18,19) and prostate lesions (15).…”

Assessment of Tumor Stiffness With Shear Wave Elastography in a Human Prostate Cancer Xenograft Implantation Model

“…Correas et al claimed that a 35‐kPa threshold on SWE may provide additional information for detection and biopsy guidance of prostate cancer. Boehm et al demonstrated that SWE may be helpful in selecting patients for biopsy. However, the diagnostic capabilities of SWE were different, and the pathologic bases were not clear enough.…”

Real-Time Elastography in the diagnosis of prostate cancer: a systematic review

“…The main characteristics are reported in Table I. Three groups are set in different dimensions: pooled analysis by patient in 16 studies [12,16,17,19,[23][24][25][26][27][28][29][30][31][32][33][34], by core in 9 studies [11][12][13][14][15][16][17][18][19] and by image in 3 studies [20][21][22]. In these studies, 2094 patients, 12145 cores and 2182 images were analyzed respectively.…”