Prostate ultrasound--for urologists only? - PubMed (original) (raw)

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Prostate ultrasound--for urologists only?

Ferdinand Frauscher et al. Cancer Imaging. 2005.

Abstract

The value of ultrasound (US) in the diagnosis of prostate cancer has dramatically increased in the past decade. This is mainly related to the increasing incidence of prostate cancer, the most common cancer in men and one of the most important causes of death from cancer in men. The value of conventional gray-scale US for prostate cancer detection has been extensively investigated, and has shown a low sensitivity and specificity. Therefore conventional gray-scale US is mainly used by urologists for guiding systematic prostate biopsies. With the development of new US techniques, such as color and power Doppler US, and the introduction of US contrast agents, the role of US for prostate cancer detection has dramatically changed. Advances in US techniques were introduced to further increase the value of US contrast agents. Although most of these developments in US techniques, which use the interaction of the contrast agent with the transmitted US waves, are very sensitive for the detection of microbubbles, they are mostly unexplored, in particular for prostate applications. Early reports of contrast-enhanced US investigations of blood flow of the prostate have shown that contrast-enhanced US adds important information to the conventional gray-scale US technique. Furthermore, elastography or 'strain imaging' seems to have great potential in prostate cancer detection. Since these new advances in US are very sophisticated and need a long learning curve, radiologists, who are overall better trained with these new US techniques, will play a more important role in prostate cancer diagnosis. Current trends show that these new US techniques may allow for targeted biopsies and therefore replace the current 'gold standard' for prostate cancer detection--the systematic biopsy. Consequently the use of these new US techniques for the detection and clinical staging of prostate cancer is promising. However, future clinical trials will be needed to determine if the promise of these new US advances of the prostate evolves into clinical application.

International Cancer Imaging Society.

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Figures

Figure 1

Figure 1

(1) Transverse gray-scale US image of the prostate. The isoechoic cancer on the left side is not visible; however it was detected by systematic biopsy. Reprinted with permission: Radiologe 2005; 45: 544–51. (2) Power Doppler US of the prostate. A hypervascular area is seen on the left side, which proved to be prostate cancer. Reprinted with permission: Radiologe 2005; 45: 544–51. (3) Contrast-enhanced color Doppler US of the prostate. (a) Transverse gray-scale US image of the prostate shows no focal abnormality. (b) Transverse color Doppler US image of the prostate shows no focal hypervascularity. (c) Transverse contrast-enhanced color Doppler US image of the prostate shows focal hypervascularity on the left side, which has proved to be prostate cancer. Reprinted with permission: Radiologe 2005; 45: 544–51. (4) Contrast-enhanced color Doppler US of the prostate in comparison with MVD. (a) Transverse contrast-enhanced color Doppler US image of the prostate shows focal hypervascularity on the right side, which has proved to be prostate cancer. (b) Immunhistochemistry shows high MVD of this cancer. Reprinted with permission: Radiologe 2005; 45: 544–51. (5) Gray-scale harmonic imaging of the prostate: (a) Continuous image shows no focal enhancement. (b) Intermittent gray-scale harmonic US shows focal enhancement on the left side (Gleason 7 cancer). Reprinted with permission: Radiologe 2005; 45: 544–51. (6) Real-time elastography of the normal prostate. No suspicious lesion is visualized. (7) Real-time elastography of a patient with prostate cancer. No suspicious lesion is visualized on the gray-scale US, whereas real-time elastography shows a stiffer area—corresponding to the cancer area—on the left side.

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