Due to a suspected overtreatment of potentially low-risk tumors, active surveillance is an integral part of PCa treatment. One concern of patients and urologists is the risk of missing a spot with a high-risk tumor (upstaging) and an extracapsular extension of the tumor (upgrading). To handle this fact minimal invasive imaging techniques for detection and staging of prostate cancer (PCa) are rising. One of these methods is shearwave elastography (SWE). It allows operator independent cancer detection by using focused ultrasound pulses for locally deforming tissue....

In 53 consecutive patients prior treatment with radical prostatectomy due to a localized prostate cancer, a whole prostate gland shearwave elastography was performed [Video: Fig. 2]. Patients were classified in high-, intermediate- and low-risk prostate cancer patients according to D’Amico risk stratification [3]. Elasticity was recorded in twelve areas: Left and right part of the ventral and dorsal of the apex, mid-gland and base of the prostate [Figure 1]. Positive areas in the elastogram with a stiffness >50kPa, respectively >100kPa were correlated with the final...

Pathologic workup revealed a pT2, pT3a, pT3b and pN1 stage in 27, 11, 15 and 10 patients. Median size of cancer lesions was 4.9 ccm, (0.29- 110 ccm). In multivariable analyses, the number of stiff areas ≥50 kPa (Odd’s ratio: 1.39; CI: 1.14-1.77; p=0.0008; AUC: 0.75). Respectively when ≥100 kPa was used as a cut off, (Odd’s ratio: 2.2; CI: 1.55-3.52; p<0.0001; AUC: 0.86) emerged as an independent predictor for extra capsular extension [Figure 3 + 4]. Similarly, also the tumor volume is correlated with...

Shearwave elastography helps assessing organ confinement in prostate cancer patients. Therefore, it may enrich active surveillance protocols and may improve prostate biopsy strategies. Validation of these findings in an active surveillance cohort is on the way.

1. Chang JM, Won JK, Lee KB, Park IA, Yi A, Moon WK. Comparison of shear-wave and strain ultrasound elastography in the differentiation of benign and malignant breast lesions. AJR Am J Roentgenol. 2013;201(2):W347-56. Epub 2013/07/26. 2. Barr RG, Memo R, Schaub CR. Shear wave ultrasound elastography of the prostate: initial results. Ultrasound quarterly. 2012;28(1):13-20. Epub 2012/02/24. 3. D'Amico AV, Whittington R, Malkowicz SB, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. Jama....