Diagnosis of prostate cancer relies on PSA-testing and digital rectal examination (DRE). Sextant prostate biopsy is still recommended for diagnosis [1]. These approaches lead to both over- and underdiagnosis. False positive elevated PSA-levels result in unnecessary biopsies or on the other hand patients with negative sextant biopsies have a significant prostate cancer [2]. Therefore, urologists need further options to evaluate prostate cancer risk for their patients. Shearwave Elastography (SWE) allows cancer detection by using focused ultrasound pulses for locally deforming tissue. These differences in tissue...

Before radical prostatectomy (RP), SWE scanning of the whole prostate gland was performed in 60 consecutive high-, intermediate- and low-risk patients. Localization of suspect lesions and density threshold (kPa) were recorded in twelve areas (left and right part of the ventral and dorsal of the apex, mid-gland and base of the prostate) and resulted in 703 different fields. Correlation between SWE findings and final pathology was performed by using whole mount sections of the prostate. Initially, 381 areas were used for establishing SWE cut-offs (development...

Median size of cancer lesions was 26 mm (18-41mm). Pathologic workup revealed a pT2, pT3a and pT3b and pN1 stage in 30, 11, 19 and 14 patients. Significant differences were recorded for SWE-elasticity of benign tissue vs. prostate cancer nodules: 42 kPa; 29-71.3 kPa vs. 88 kPa; 54-123 kPa (all p<0.001). (Tbl.2) Applying the best threshold of 50 kPa to the validation cohort resulted in an 80.9 and 69.1 sensitivity and specificity with an accuracy of 74.2 for detecting cancer nodules based on final pathological...

Our results demonstrate the feasibility of SWE for identifying cancer foci based on SWE differences in 703 fields. Moreover, reliable cut-offs for this approach can be established. Multi-institutional validation of these cut-offs is necessary.

1. Heidenreich, A., et al., EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. European urology, 2011. 59(1): p. 61-71. 2. Mian, B.M., et al., Predictors of cancer in repeat extended multisite prostate biopsy in men with previous negative extended multisite biopsy. Urology, 2002. 60(5): p. 836-40. 3. Brock, M., et al., The impact of real-time elastography guiding a systematic prostate biopsy to improve cancer detection rate: a prospective study of 353 patients. The Journal of urology, 2012. 187(6):...