A COMPARATIVE STUDY OF DIAGNOSTIC ACCURACY FOR PROSTATE CANCER DETECTION BETWEEN ELASTOGRAPY PLUS MRI IMAGE BASED TRUS BIOPSY VERSUS EXTENDED CORE BIOPSY

Volume : VII, Issue : V, May - 2018

Leelakrishnan, Govindarajan Ramanujam, Aravindh Rathinam

BACKGROUND: Prostate cancer is the most common malignancy in men in the western world (1) Serum prostate–specific

antigen (PSA) with levels > 4.0 ng/mL considered as abnormal has been used as a screening test for prostate cancer. However,

various benign diseases such as acute prostatitis, benign prostatic hypertrophy and previous therapeutic intervention of the

prostate can lead to elevated PSA levels; therefore false–positive results from PSA test are not uncommon.(2) Although blind

finger guided transrectal biopsy has been replaced by TRUS guided biopsy,still cancer detection rate is not increased. In this study

,a comparison has been made of diagnostic accuracy of carcinoma prostate detection between elastograpy plus MRI image

based trus biopsy versus extended core biopsy .

AIM AND OBJECTIVES: To study and compare the diagnostic accuracy for prostate cancer detection by TRUS guided extended

core biopsy and elastography plus MRI image based TRUS biopsy .

To study which of the two technique is more sensitive in detection of prostate cancer and to compare the Gleason score of biopsy .

MATERIAL AND METHODS: We included 25 patients with no clinical suspicious of malignancy and with Serum PSA greater

than 4.0 ng/dl . All patient had no hard nodule in DRE. All patients underwent Multiparametric MRI and Elastography . The lesions

that are positive in both MRI and Elastography were taken for TRUS guided biopsy.Then random Extended core biopsy taken. All

were sent in a separate container for histopathology. Histopathology report is analysed for adenocarcinoma, gleason

pattern,score and number of cores positive .Group A consist of cores from MRI and Elastograpy guided TRUS biopsy and Group B

is cores from Extended core biopsy. Both group were compared.

RESULTS The incidence of prostate cancer detection by MRI plus Elastrography guided TRUS is 13 cases (86.6%).

This biopsy method is considered to be statistically significant as the p value is 0.0387 as obtained by fishers exact test, since p <

0.05. In patients who had prostatic carcinoma, ca detection was 100% (n=22). The sensitivity of mpMRI plus Elastography image

based TRUS biopsy method in detecting Pca is 81.90% and specificity is 80 %.The positive predictive value of this 81%.

CONCLUSION: Although mpMRI and Elastography are individually useful for detection of prostate malignancy ,combining both

the diagnostic tools for TRUS guided increases the rate of cancer detection than that of Extended core biopsy. This also upgrades

the Gleason score and sum also.