COMPLEX TRANSRECTAL US WITH COLOR FLOW MAPPING, DOPPLER SONOGRAPHY AND SONOELASTOGRAFIEY IN PROSTATE CANCER EVALUATION

Oncology statistics shows steady increase of prostate cancer, since early diagnosis and adequate treatment are crucial. Among prostate imaging modalities sonoelastography (SEG) has a special value for identifying suspicious dense foci in prostate, however more studies are still required to establishing accuracy and specificity with different SEG techniques for updating the prostate cancer diagnostics protocol.The aim of study was to evaluate sonoelastography capabilities for ultrasound guided prostate biopsy, comparing with gray scale and Doppler modalities.

512 consecutively selected patients were examined (mean age of 56 years, mean prostate volume was 54 cm3, the average PSA about 14.3 ng/ml). All patients underwent prostate cancer diagnostic algorithm, including direct rectal exam, PSA level, transrectal ultrasound (TRUS) with Doppler and SEG identification of suspicious foci, mostly in peripheral zones, followed by 10-point biopsy guided by ultrasound. According to aim we assigned patients to 4 groups: group 1 (n = 327) underwent gray scale and Doppler US guided prostate biopsy; in patients of group 2 (n = 106) – additionally SEG was applied (3 patients of this group was also performed MRI and MRS of the prostate); in group 3 there were patients with high level of PSA and negative TRUS guided biopsy; group 4 – of 41 patiens with prostatectomy and biochemical recidive of prostate.

Among 430 cases included to this study in 318 patients (74 %) prostate adenocarcinoma was revealed, in 270 (63 %) patients – benign hyperplasia (BH). In group 1 cancer was diagnosed in 236 (72.1 ± 2.4 %) patients, in group 2 – in 84 (79.2 ± 3.8 %). 19 false negative and 6 false positive results were registered in SEG enchanced US guided prostate biopsy. Routine TRUS indicate lesions with mean sizes about 0.8 ± 0,21 sm in compare with 0,5 ± 0,08 sm which were diagnose by SEG. Locuses which were marked as benign byTRUS with SEG hade never conatained neoplastic cells. TRUS guided biopsy in patients of group 3 had estimated prostate cancer in 10 cases (45,5 %) of 22 patients where prostate cancer was assumed after multiparametric MRI. Biopsy confirmed nononcological character of prostate lesions which were marked as benign by MRI. In group 4 all TRUS examinations were unsensitive. – local recurrence was found only in one case in compare with 14 verified cases detected by MRI.

Using ultrasonic guided SEG assisted algorithm is significantly more effective than usial gray scale US for prostate cancer detection. Thus SEG TRUS guided biopsy shown higher cancer detection level over routine gray scale TRUS (p < 0.05): sensitivity was increased from 71 to 77 % (p < 0.05), specificity from 62 to 69 % (p < 0.05). But in complicated cases US diagnostics has to be supplied by multiparametric MRI.

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