Sweep and Scrutinize: Improving Prostate Cancer Diagnostic Efficacy by Combining Whole-Gland Contrast-Enhanced Transrectal Ultrasound With Fixed-Plane Flash-Replenishment Imaging.

OBJECTIVES

To evaluate whether the addition of whole-gland contrast-enhanced transrectal ultrasound (CETRUS) and fixed-plane flash-replenishment imaging (FRI) to conventional transrectal ultrasound (TRUS) improves the diagnostic efficacy of prostate cancer (PCa) in patients with prostate-specific antigen (PSA) levels of 4.00-20.00 ng/mL.

METHODS

A total of 163 patients scheduled for TRUS-guided biopsy due to elevated PSA (4.00-20.00 ng/mL) were enrolled. Each patient underwent conventional TRUS, whole-gland CETRUS, and FRI before biopsy. Detection rates and diagnostic efficacy for PCa were compared among 3 imaging strategies: conventional TRUS alone, the combination of conventional TRUS with whole-gland CETRUS, and the triple combination.

RESULTS

PCa was diagnosed in 62 of 163 (38.04%), including 29 (46.77%) clinically significant cases. The detection rates were 43.56% for conventional TRUS, 57.06% for conventional TRUS combined with whole-gland CETRUS, and 61.35% for the triple combination. Only 5 clinically insignificant cases were missed by the combined approach. The triple combination demonstrated the highest area under the ROC curve (AUC = 0.747), significantly outperforming conventional TRUS (AUC = 0.669, p = .018) and TRUS with whole-gland CETRUS (AUC = 0.703, p = .026). The combined method also identified significantly more positive biopsy cores (p-Bonf < .001) by integrating the complementary diagnostic strengths of whole-gland CETRUS (high positive predictive value (PPV) for rapid/hyperenhancement and diffuse abnormalities) and FRI (high PPV for asymmetric/focal enhancement).

CONCLUSION

The triple-modality combination significantly improves PCa detection rate and diagnostic efficacy in patients with PSA levels of 4.00-20.00 ng/mL, offering a valuable alternative when magnetic resonance imaging is contraindicated or unavailable.