Value of Real-Time Elastography Targeted Biopsy for Prostate Cancer Detection in Men With Prostate Specific Antigen 1.25 ng/ml or Greater and 4.00 ng/ml or Less

Aigner, Friedrich; Pallwein, Leo; Junker, Daniel; Schäfer, Georg; Mikuz, Gregor; Pedross, Florian; Mitterberger, Michael Josef; Jaschke, Werner; Halpern, Ethan J.; Frauscher, Ferdinand

doi:10.1016/j.juro.2010.05.026

« Previous Next »The Journal of Urology
Volume 184, Issue 3 , Pages 913-917, September 2010

Value of Real-Time Elastography Targeted Biopsy for Prostate Cancer Detection in Men With Prostate Specific Antigen 1.25 ng/ml or Greater and 4.00 ng/ml or Less

Friedrich Aigner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
- Correspondence: Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria (telephone: ++43-512-504-82091; FAX: ++43-512-504-24823)
Leo Pallwein
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
Daniel Junker
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
Georg Schäfer
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
Gregor Mikuz
- Department of Pathology, Medical University of Innsbruck, Innsbruck, Austria
Florian Pedross
- Department of Medical Statistics, Informatics and Health, Medical University of Innsbruck, Innsbruck, Austria
Michael Josef Mitterberger
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
Werner Jaschke
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
Ethan J. Halpern
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
Ferdinand Frauscher
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria

Received 11 February 2010 published online 20 July 2010.

Purpose

We assessed the prostate cancer detection rate of real-time elastography targeted biopsy in men with total prostate specific antigen 1.25 ng/ml or greater and 4.00 ng/ml or less.

Materials and Methods

Real-time elastography using an EUB 8500 Hitachi ultrasound system (Hitachi Medical, Tokyo, Japan) was done in 94 men with a mean age of 57.4 years (range 35 to 77) with increased prostate specific antigen between 1.25 ng/ml or greater and 4.00 ng/ml or less (mean 3.20, range 1.30 to 4.00) and a free-to-total prostate specific antigen ratio of less than 18%. Real-time elastography was done to evaluate peripheral zone tissue elasticity and hard areas were defined as suspicious. Targeted biopsies with a maximum of 5 cores were done in suspicious areas, followed by 10-core systematic biopsy. We analyzed the cancer detection rate of real-time elastography and systematic biopsy.

Results

Cancer was found in 27 of 94 patients (28.7%). Real-time elastography detected cancer in 20 patients (21.3%) and systematic biopsy detected it in 18 (19.1%). Positive cancer cores were found in real-time elastography targeted cores in 38 of 158 cases (24%) and in systematic cores in 38 of 752 (5.1%) (chi-square test p <0.0001). The cancer detection rate per core was 4.7-fold greater for targeted than for systematic biopsy.

Conclusions

Real-time elastography targeted biopsy allows prostate cancer detection in men with prostate specific antigen 1.25 ng/ml or greater and 4 ng/ml or less with a decreased number of cores compared with that of systematic biopsy.

Key Words: prostate, prostatic neoplasms, prostate-specific antigen, elasticity imaging techniques, biopsy

Abbreviations and Acronyms: DRE, digital rectal examination, MRI, magnetic resonance imaging, NPV, negative predictive value, PCa, prostate cancer, PPV, positive predictive value, PSA, prostate specific antigen, RTE, real-time elastography, TZ, transition zone