Can multiparametric ultrasound improve cognitive MRI/TRUS fusion prostate biopsy

Abstract

Objective: To evaluate the accuracy of multiparametric transrectal ultrasound (contrast- enhanced ultrasound plus elastosonography) in the detection of the suspicious area diagnosed by multiparametric magnetic resonance (mpMRI). Materials and methods: From June 2018 to June 2019 60 men (median age 63 years) with persistent suspicion of cancer underwent repeat saturation biopsy following pelvic mpMRI and the lesions characterized by a PI-RADS (Prostate Imaging Reporting and Data System) score ≥ 3 were submitted to 4 additional cores by transperineal cognitive fusion biopsy (TPBx). All patients, before prostate biopsy, underwent contrast- enhanced ultrasound (CEUS) following intravenous administration of a bolus of Sonovue® (2.4 mg of nonpyrogenic suspension of phospholipid/sulphur hexaphloride); in addition, a transrectal elastosonography (TRES) was done to evaluate prostate tissue elasticity. The accuracy of multiparametric ultrasound to detect the mpMRI lesions was evaluated. Results: In 27/60 (45%) of men a T1c prostate cancer (PCa) was diagnosed by TPBx and 21 (77.8%) of them were classified as clinically significant cancer (csPCa); in detail, 16/21 (76.2%) vs. 5/21 (23.8%) csPCa were located in the peripheric and anterior zone of the gland, respectively. Median total PSA was 10.3 ng/ml (range: 4.9-51 ng/ml). TRES and CEUS were positive for csPCa only in 6/21 (28.5%) and 13/21 (62%) of TPBx showing an increased accuracy directly related with the PI-RADS scores Conclusions: Multiparametric ultrasound using TRES and CEUS after Sonovue® administration did not improve the accuracy of TPBx in diagnosing csPCa.