Value of multi-modal guided transrectal ultrasonography prostate biopsies in improving prostate cancer detection

Objective To study the utility of multi-modal guiding in transrectal ultrasound-guided prostate biopsies. Methods A total of 115 consecutive patients suspicious for prostate cancer due to elevated serum prostate specific antigen level were enrolled in this prospective study. All patients underwent transrectal ultrasound (TRUS), transrectal real-time elastography (TRTE) and contrast-enhanced transrectal ultrasound (CETRUS). Both positive sites on above imaging studies and 6 core-systematic biopsy sites were included in transrectal biopsy. The impact of targeted biopsies on the prostate cancer detection rate was analyzed in comparison with prostate biopsy pathology. Results The overall prostate cancer detection rate was 55% (63/115). TRTE and CETRUS had a higher sensitivity, specificity and accuracy of 71% (45/63), 81% (42/52), 76% (87/115), and 65% (41/63), 83% (43/52), 73% (84/115), respectively. Compared with TRUS, TRTE and CETRUS guided targeted biopsy improve the sensitivity of prostate cancer ( χ2=14.950, 10.754, P=0.002, 0.013), specificity ( χ2=0.256, 20.021, P=0.006, 0.009), accuracy ( χ2=5.735,10.361, P=0.020, 0.011). Targeted biopsy could improve the detection rate of prostate cancer ( χ2=9.021, 23.176, P=0.042, 0.000). On the operating characteristic (ROC) curve of TRTE, the area under the curve was 0.834 with a 95% confidence interval of 0.742-0.926. Conclusion Combined with the application of new technology of ultrasound to improve positive rate of prostate cancer, improving the multi-mode ultrasound-guided prostate biopsy positive rate, and has important clinical significance for early screening and diagnosis of prostate cancer.