Comparison of real‐time elastography with grey‐scale ultrasonography for detection of organ‐confined prostate cancer and extra capsular extension: a prospective analysis using whole mount sections after radical prostatectomy

Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Current studies evaluating real‐time elastography in patients prior to radical prostatectomy reported sensitivities between 57% and 100% for detection of prostate cancer. This is the first prospective study comparing the findings of real‐time elastography and conventional gray‐scale ultrasound with final pathology. A significant improvement for cancer detection as well as detection of extra capsular is shown by adding the attributes of tissue elasticity to current gray‐scale imaging. OBJECTIVE • To evaluate whether transrectal real‐time elastography (RTE) improves the detection of intraprostatic prostate cancer (PCa) lesions and extracapsular extension (ECE) compared with conventional grey‐scale ultrasonography (GSU). PATIENTS AND METHODS • In total, 229 patients with biopsy‐proven PCa were prospectively screened for cancer‐suspicious areas and ECE using GSU and RTE. • The largest tumour focus detected by RTE was defined as the index lesion. • The prostate gland was stratified into six sectors on GSU and RTE, which were compared with histopathological whole mount sections after radical prostatectomy. RESULTS • Histopathologically, PCa was confirmed in 894 out of 1374 (61.8%) evaluated sectors and ECE was identified in 47 (21%) patients. • Of these 894 sectors, RTE correctly detected 594 (66.4%) and GSU 215 (24.0%) cancer suspicious lesions. • Sensitivity was 51% and specificity 72% using RTE compared to 18% and 90% for GSU. • RTE identified the largest side specific tumour focus in 68% of patients. • ECE was identified with a sensitivity of 38% and specificity of 96% using RTE compared to 15% and 97% using GSU. CONCLUSIONS • Compared with GSU, RTE provides a statistically significant improvement in detection of PCa lesions and ECE. • RTE enhances GSU, although improvement is still needed to achieve a clinically meaningful sensitivity.