Impact Of Transrectal Real-time Tissue Elastography Combined With Peak Strain Index For Diagnosing Clinically Signifcant Prostate Cancer

Objective: 1.To evaluate transrectal real-time tissue elastography(RTE)combined with the quantitative parameter of peak strain index(PSI)in diagnosis of prostate cancer(prostate cancer,PCa)in the peripheral zone.2.To evaluate transrectal RTE targeted prostate biopsy and systematic biopsy.3.To evaluate transrectal RTE targeted prostate biopsy in the peripheral zone combined with PSI for diagnosing clinically signifcant PCa.Materials and Methods: 1.A total of 141 patients with suspicious PCa lesions in the peripheral zone were scheduled for biopsy.Their average age of 71.6 years(49~90 years),PSA of 30 ng/ml(0.5~190.0 ng/ml)and volume of 50.3 ml(15.8~178.5 ml)were measured.All the patients underwent transrectal ultrasound(TRUS)and transrectal RTE.2.Quantitative analysis of RTE.All the elastograms and the results of prostate biopsy were recorded.According to the quantitative analysis of elastogram by RTE,local strain index of peak elasticity in lesions(PSI)were calculated.The receiver operating characteristic(ROC)curve was used to evaluate the value of PSI.PSI was was compared with the pathological findings.3.All the 141 patients underwent prostate biopsy.Two-core RTE combined with PSI targeted prostate biopsy was taken and subsequently a 10-core systematic biopsy was tanken.The data of targeted biopsy and systematic biopsy in prostate were both reviewed and statistically compared.The Gleason score distribution of PCa patients between RTE combined with PSI targeted biopsy and 10-core systematic biopsy were compared.The Gleason grading of PCa lesions was compared with the PSI values.Result: 1? Study of transrectal real-time tissue elastography combined with quantitative parameters for the diagnosis of prostate cancer The area under the ROC curve of PSI and PSA were 0.95 and 0.83 respectively(P < 0.01)for differential diagnosing PCa of the peripheral zone.The average PSI value(24.97)in PCa group was significantly higher than that in benign prostatic disease group(3.02)(P < 0.0001).When a cutoff point of 5.97 was used,PSI had 87.5% sensitivity,88.6% specificity.When a cutoff point of 10.1 was used,PSA had 80% sensitivity,72.2% specificity.2? Study of transrectal real-time tissue elastography combined with quantitative parameter guided biopsy for the diagnosis of prostate cancer(1)One hundred and forty-one patients underwent transrectal RTE combined with PSI and 159 suspicious cancerous foci were detected.The positive incidence of PCa in 2-core RTE-targeted biopsy was 44% while in 10-core systematic biopsy was 30.2%(P < 0.05).RTE targeted biopsy core had a signifcantly higher sensitively for detecting PCa.(2)Among the 72 patients diagnosed with PCa,87.5% of all cases were detected using RTE-targeted biopsy,86.1% using systematic biopsy(P = 0.525).(3)The detection rates of PCa by RTE-targeted biopsy in the apex,mid-gland and base were 41%,43% and 16%,respectively(P < 0.05).Using RTE-targeted biopsy,an increased number of positive PCa cores were identifed in the apex and mid-gland.3? Value of transrectal real-time tissue elastography combined with quantitative parameter guided biopsy for the diagnosis of clinically significant prostate cancer(1)When a cutoff point of 5.97 was used,PSI with RTE targeted biopsy could detected more clinically significant PCa(P=0.0253).(2)There was a positive correlation between PSI and pathological Gleason score in the degree of malignancy of PCa(r=0.28,P = 0.017).Conclusion: 1.RTE combined PSI is helpful for differential diagnosing PCa of the peripheral zone.2.PSI is more valuable than PSA in diagnosing PCa of the peripheral zone.3.PCa detection rates of RTE combined PSI targeted biopsy and systemic biopsy were consistent.RTE targeted biopsy core had a higher sensitivity for detecting PCa.4.PSI could detect more clinically signifcant prostate cancer in the peripheral zone.