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Review
. 2020 Jun;9(3):1492-1500.
doi: 10.21037/tau.2020.02.26.

Can transrectal prostate ultrasound compete with multiparametric MRI in the detection of clinically significant prostate cancer?

Alistair D R Grey  1   2   3   4 , Martin J Connor  1 , Joseph Tam  1 , Tillmann Loch  5
Affiliations
Review

Can transrectal prostate ultrasound compete with multiparametric MRI in the detection of clinically significant prostate cancer?

Alistair D R Grey et al. Transl Androl Urol. 2020 Jun.

Abstract

We consider the current and future role of transrectal ultrasound imaging in the diagnosis of prostate cancer, with a particular focus on the pre-biopsy localization and targeting role that multiparametric MRI (mpMRI) has come to occupy for some men in recent years. We draw a distinction between transrectal ultrasound (TRUS) used only as a means of distributing zonal biopsies with its employment as a means for identifying and targeting sonographically abnormal lesions. The role of AI in lesion identification and targeting will be reviewed. Comparisons of cost and availability, frequency of contraindications and diagnostic accuracy between these two imaging modalities will be drawn.

Keywords: Prostate cancer; artificial neural network analysis; multiparametric MRI (mpMRI); multiparametric ultrasound; transrectal ultrasound (TRUS).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tau.2020.02.26). The series “Prostate Imaging and Focal Therapy” was commissioned by the editorial office without any funding or sponsorship. MJC served as the unpaid Guest Editor of the series. ADR Grey has received salary payments from Prostate Cancer UK and the Moulton foundation grant, for his work on the CADMUS trial (ISRCTN38541912) investigating the role of multiparametric ultrasound in clinically significant prostate cancer detection. Hitachi and BK ultrasound provided hardware and software upgrades at reduced cost to facilitate this trial. MJ Connor conducts prostate cancer research funded by the Welcome Trust and University College London Hospital charity. T Loch is inventor of the ANNA/C-TRUS method and shareholder of ANNA Technologies/Deutschland, has received consultation fees from ANNA Technologies and has received teaching equipment from BK Medical. Dr. Tam has no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Targeting of sonographically abnormal lesions on b-mode ultrasound. Left and middle: 1 and 0.5 cm hypoechoic lesion on transverse image. Left transverse and right longitudinal image: simulation of optimal TRUS lesion targeted biopsy.
Figure 2
Figure 2
Axial DCE and sagittal multiparametric MRI images showing spherical (black) voids left by Urolift implants.
Figure 3
Figure 3
Ukimura et al. (34) demonstrate clearly visible TRUS lesions of patients with MRI positive findings in which the TRUS image information was utilized to direct biopsies. TRUS, transrectal ultrasound.
Figure 4
Figure 4
ANNA marks invisible cancer suspicious areas in red. Targeted biopsies revealed Gleason Score 3+4=7a prostate cancer.
Figure 5
Figure 5
mpUSS identification of prostate cancer. Images taken from CADMUS pilot (19).
See this image and copyright information in PMC

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