Ultrasound in the Diagnosis of Prostate Cancer

Prostate cancer continues to be the second most common occurring cancer in men1. According to The American Cancer Society, the estimated number of new cases for 20171 are:

Cancer estimates

The good news is the survival rates are quite remarkable1:

  • 99% at 5 years
  • 98% at 10 years
  • 96% at 15 years

Prostate Cancer Diagnosis

Early detection is one of the most important factors in the successful treatment of any cancer. For the prostate, initial screening tools include:

  1. Prostate Specific Antigen (PSA) blood test: Elevation of PSA can be an early indication of prostate cancer2.
  2. Digital Rectal Examination (DRE): Nodules can often be palpated, as well as prostate enlargement, both of which can be early indicators of prostate cancer2
  3. Transrectal Ultrasound (TRUS) of the prostate: Ultrasound is used to identify suspicious nodules within the prostate. TRUS is also used to calculate prostate volume. Nodules and prostate volume enlargement can be early indicators of prostate cancer2.
  4. Transrectal Ultrasound Guided Biopsy: Once the suspicion of prostate cancer is elevated enough, the next step is usually biopsy. Currently, a 12-core biopsy of the prostate is the common approach2. However, MRI/ultrasound fusion biopsy is rapidly gaining popularity3.

While prostate songraphy has been around for more than 4 decades, it is currently undergoing a bit of a renaissance. This resurgence can be attributed to several factors, primarily the on-going improvements and utilization of:

  • Prostate MRI/ultrasound fusion imaging and biopsy
  • Prostate contrast imaging and biopsy
  • The increased utilization of SpaceOAR®

 

Prostate MRI/ultrasound Fusion Imaging and Biopsy

Prostate MRI/ultrasound fusion imaging and biopsy are powerful advancements in the visualization  and subsequent biopsy of suspicious prostate nodules and biopsy guidance. Historically, transrectal ultrasound (TRUS) of the prostate has not been as accurate at identifying suspicious nodules within the prostate as MRI3,4.

Ultrasound image

According to a recent online article by the Journal of American Medical Association (JAMA):

A patient’s wife once told urology surgeon Peter Pinto, MD that there was no way she’d agree to have a dozen biopsy needles stuck blindly into her breast just because a blood test suggested she might have cancer. But that’s exactly what happens with many men whose cancer screening test reveals an elevated level of PSA in their blood. Although mammography provides images of suspicious breast lesions to guide biopsies, prostate cancer is the only type of solid organ tumor that is usually diagnosed sight unseen with hit-or-miss tissue biopsies5.

MRI/ultrasound fusion biopsy can be performed using a transrectal or transperineal approach using a  CIVCO endocavity balloon for accurate prostate positioning and a CIVCO Micro-Touch™ Stabilizer with the Classic or .

Stepper

 

Prostate Contrast Imaging and Biopsy

Contrast enhanced ultrasound (CEUS) may improve the visualization of the prostate and better detect specific areas of  cancer. CEUS uses  intravenous contrast to better visualize areas of increased blood flow within the prostate, which may be indicative of latent prostate cancer.

Global research has produced numerous studies demonstrating improved prostate cancer detection with the use of  contrast-enhanced ultrasound biopsy techniques.. Vascular areas visualized and targeted for biopsy using these techniques yield improved  cancer detection rates.

Targeted biopsies using CEUS of the prostate have higher yield for prostate cancer detection and may prove useful for the initial evaluation of patients with elevated PSA6.

 

Increasing Utilization of SpaceOAR®

Brachytherapy and external beam radiation therapy are popular treatments for prostate cancer2. The potential side effects from these treatments include damage to the rectal wall due to radiation. Placed between the prostate and rectum, SpaceOAR hydrogel pushes the rectum out of the high dose radiation region.

Prostate anatomy

Image courtesy of Augmenix

The use of SpaceOAR has been shown to significantly reduce those potential side effects from radiation involving the bowel, urinary system and sexual function7,8.

Multipurpose WorkstationSpaceOAR hydrogel placement is performed as an outpatient procedure by Augmenix certified appliers. Application requires the use of transrectal ultrasound, CIVCO endocavity balloon, and a stabilizer/stepper system such as the CIVCO Multi-Purpose WorkstationTM.

Prostate sonography has been around over four decades, but its popularity is increasing with the advent of new technologies such as fusion, contrast enhanced imaging, and the increased use of hydrogel.

CIVCO has been a leader in the development and innovation of much of the equipment necessary to perform these procedures. You can find additional information on the referenced and all CIVCO products at www.CIVCO.com.

Prostate Cancer Treatment with Ultrasound

Watch the CIVCO Guidelines Blog for the follow-up blog post on ultrasound in the treatment of prostate cancer.

COPYRIGHT ©2018. ALL RIGHTS RESERVED. CIVCO IS A REGISTERED TRADEMARK OF CIVCO MEDICAL SOLUTIONS. MICRO-TOUCH STABILIZERS, CLASSIC STEPPERS, EX3 STEPPERS, AND MULTI-PURPOSE WORKSTATION ARE TRADEMARKS OF CIVCO. ALL OTHER TRADEMARKS ARE THE PROPERTY OF THEIR RESPECTIVE OWNERS. ALL PRODUCTS MAY NOT BE LICENSED IN ACCORDANCE WITH CANADIAN LAW. 2018M-3018 REV 1

References:

  1. Siegel R, Miller K , Jemal A “Cancer Statistics, 2017” CA CANCER J CLIN 2017;67:7–30; www.cancerstatisticscenter.cancer.org/#!/cancer-site/Prostate
  2. Guidelines for the management of clinically localized prostate cancer. American Urological Association 2007, Reviewed and accepted 2011
  3. Ahmed H, Bosaily A, Brown L, Gabe R, Kaplan R, Parmar M, Collaco-Moraes Y , Ward K, Hindley R, Freeman A, Kirkham A, Oldroyd R, Parker C, Emberton M, and the PROMIS study group “Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study” Lancet. 2017 Feb 25;389(10071):815-822.
  4. M Siddiqui, S Rais-Bahrami, B Turkbey, et al; “Comparison of MR/Ultrasound Fusion–Guided Biopsy with Ultrasound-Guided Biopsy for the Diagnosis of Prostate Cancer” JAMA. 2015;313(4):390-397. doi:10.1001/jama.2014.17942
  5. admetech.org/researchers-look-to-mri-and-biomarkers-to-help-improve-detection-of-aggressive-prostate-cancers/
  6. Kundavaram C, Halpern E, Trabulsi E “Value of contrast-enhanced ultrasonography in prostate cancer” Curr Opin Urol.2012 Jul;22(4):303-9
  7. Hamstra D, et al. Continued Benefit to Rectal Separation for Prostate RT: Final Results of a Phase III Trial. Int J Radiat Oncol Biol Phys; Dec. 2016 DOI
  8. Hamstra D, et al. Evaluation of sexual function on a randomized trial of a prostate rectal spacer. J Clin Oncol 35, 2017 (suppl 6S; abstract 69)

Kevin T. Rooker, RT(R), RDMS, RVT is a Clinical Marketing Specialist at CIVCO Medical Solutions. Kevin has over thirty years’ experience as a practicing Sonographer. He has devoted more than 25 years of his professional career to his passion of providing sonography education for sonographers, physicians, and other healthcare practitioners.