Carcinoma of the prostate gland is the most common neoplasm in men. Its treatment depends on multiple factors among which local staging plays a significant role. The basic method is transrectal ultrasound imaging. This examination enables imaging of the prostate gland and its abnormalities, but it also allows ultrasound-guided biopsies to be conducted. A conventional gray-scale ultrasound examination enables assessment of the size, echostructure and outlines of the anatomic capsule, but in many cases, neoplastic lesions cannot be observed. For this reason, new sonographic techniques are implemented in order to facilitate detectability of cancer. The usage of contrast agents during transrectal ultrasound examination must be emphasized since, in combination with color Doppler, it facilitates detection of cancerous lesions by visualizing flow which is not observable without contrast enhancement. Elastography, in turn, is a different solution. It uses the differences in tissue elasticity between a neoplastic region and normal prostatic parenchyma that surrounds it. This technique facilitates detection of lesions irrespective of their echogenicity and thereby supplements conventional transrectal examinations. However, the size of the prostate gland and its relatively far location from the transducer may constitute limitations to the effectiveness of elastography. Moreover, the manner of conducting such an examination depends on the examiner and his or her subjective assessment. Another method, which falls within the novel, popular trend of combining imaging methods, is fusion of magnetic resonance imaging and transrectal sonography. The application of multidimensional magnetic resonance imaging, which is currently believed to be the best method for prostate cancer staging, in combination with the availability of a TRUS examination and the possibility of monitoring biopsies in real-time sonography is a promising alternative, but it is associated with higher costs and longer duration of the examination. This paper presents the most important novel trends in transrectal imaging in prostate cancer diagnosis based on the review of the articles available in the PubMed base and published after 2010.

Rak stercza to najczęstszy nowotwór u mężczyzn. Sposób leczenia zależy od wielu czynników, wśród których bardzo ważną rolę odgrywa ocena miejscowego stopnia zaawansowania. Podstawową metodą jest tutaj ultrasonografia przezodbytnicza. Badanie to pozwala nie tylko na zobrazowanie stercza i jego nieprawidłowości, lecz także na przeprowadzenie biopsji pod kontrolą ultrasonografii. Klasyczne badanie ultrasonograficzne w skali szarości umożliwia ocenę wielkości, echostruktury stercza i zarysów torebki anatomicznej, ale w wielu przypadkach nie uwidacznia zmian nowotworowych. Z tego powodu wprowadza się nowe technologie ultrasonograficzne, aby poprawić wykrywalność raka. Warto zwrócić uwagę na zastosowanie środków kontrastujących w trakcie badania przezodbytniczego, które wraz z obrazowaniem kolorowym dopplerem poprawiają wykrywalność raka: uwidaczniają przepływy niestwierdzalne bez wzmocnienia kontrastowego. Innym rozwiązaniem jest elastografia, wykorzystująca różnicę sztywności w obszarze nowotworowym i w zdrowym, otaczającym chorą tkankę miąższu stercza. Technika ta pozwala na wykrycie zmian niezależnie od ich echogeniczności, dzięki czemu uzupełnia klasyczne badanie przezodbytnicze. Ograniczać skuteczność elastografii mogą wielkość stercza i jego dość dalekie położenie w stosunku do głowicy. Z kolei sposób wykonania badania zależy od doświadczenia badającego i jego subiektywnej oceny. Inną metodą wpisującą się w modny obecnie trend łączenia metod obrazowania jest fuzja rezonansu magnetycznego i badania ultrasonograficznego przezodbytniczego. Wykorzystanie obrazowania wielopłaszczyznowego rezonansu, uznawanego obecnie za najlepszą metodę oceny stopnia miejscowego zaawansowania raka, w połączeniu z dostępnością TRUS i łatwością monitorowania biopsji pod kontrolą ultrasonografii w czasie rzeczywistym to bardzo obiecująca alternatywa – choć wiąże się ze znacząco większym kosztem i wydłużonym czasem badania. Na podstawie przeglądu artykułów dostępnych w bazie PubMed opublikowanych po 2010 roku przedstawiono najważniejsze kierunki rozwoju badania transrektalnego w diagnostyce raka stercza.

Department of Urology Faculty of Medicine and Dentistry Palacký University Olomouc Czech Republic

Department of Urology Jagiellonian University Medical College Cracow Poland

Institute of Fundamental Technological Research Polish Academy of Science Warsaw Poland

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McDavid K, Lee J, Fulton JP, Tonita J, Thompson TD. Prostate cancer incidence and mortality rates and trends in the United States and Canada. Public Health Rep. 2004;119:174–186. PubMed PMC

Morote J, Raventós CX, Lorente JA, Lopez-Pacios MA, Encabo G, de Torres I, et al. Comparison of percent free prostate specific antigen and prostate specific antigen density as methods to enhance prostate specific antigen specificity in early prostate cancer detection in men with normal rectal examination and prostate specific antigen between 4.1 and 10 ng/ml. J Urol. 1997;158:502–504. PubMed

Yokomizo Y, Miyoshi Y, Nakaigawa N, Makiyama K, Ogawa T, Yao M, et al. Free PSA/total PSA ratio increases the detection rate of prostate cancer in twelve-core biopsy. Urol Int. 2009;82:280–285. PubMed

Brock M, von Bodman C, Sommerer F, Löppenberg B, Klein T, Deix T, et al. Comparison of real-time elastography with grey-scale ultrasonography for detection of organ-confined prostate cancer and extra capsular extension: a prospective analysis using whole mount sections after radical prostatectomy. BJU Int. 2011;108:E217–E222. PubMed

Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, et al. Rozdział Rak stercza, podrozdział Stopień zaawansowania – cecha T. EAU guidelines. 2013;7:28.

Gramiak R, Shah PM. Echocardiography of the aortic root. Invest Radiol. 1968;3:356–366. PubMed

Gramiak R, Shah PM, Kramer DE. Ultrasound cardiography: contrast study in anatomy and function. Radiology. 1969;92:939–948. PubMed

Kremkau FW, Gramiak R, Carstensen EL, Shah PM, Kramer DH. Ultrasonic detection of cavitation at catheter tips. Am J Roentgenol Radium Ther Nucl Med. 1970;110:177–183. PubMed

Lauterborn W. Numerical investigation of nonlinear oscillation of gas bubbles in liquids. J Acoust Soc Am. 1976:283.

Medwin H. In situ acoustic measurements of microbubbles at sea. Journal of Geophysical Research. 1977;82:971–976.

de Jong N, Hoff L, Skotland T, Bom N. Absorption and scatter of encapsulated gas filled microspheres: theoretical considerations and some measurements. Ultrasonics. 1992;30:95–103. PubMed

Furlow B. Contrast-enhanced ultrasound. Radiol Technol. 2009;80:547–561. PubMed

Wilson SR, Greenbaum LD, Goldberg BB. Contrast-enhanced ultrasound: what is the evidence and what are the obstacles? AJR Am J Roentgenol. 2009;193:55–60. PubMed

Halpern EJ, Ramey JR, Strup SE, Frauscher F, McCue P, Gomella LG. Detection of prostate carcinoma with contrast-enhanced sonography using intermittent harmonic imaging. Cancer. 2005;104:2373–2383. PubMed

Aigner F, Pallwein L, Mitterberger M, Pinggera GM, Mikuz G, Horninger W, et al. Contrast-enhanced ultrasonography using cadence-contrast pulse sequencing technology for targeted biopsy of the prostate. BJU Int. 2009;103:458–463. PubMed

Brawer MK, Deering RE, Brown M, Preston SD, Bigler SA. Predictors of pathologic stage in prostatic carcinoma. The role of neovascularity. Cancer. 1994;73:678–687. PubMed

Ismail M, Petersen RO, Alexander AA, Newschaffer C, Gomella LG. Color Doppler imaging in predicting the biologic behavior of prostate cancer: correlation with disease-free survival. Urology. 1997;50:906–912. PubMed

Halpern EJ, Frauscher F, Forsberg F, Strup SE, Nazarian LN, O'Kane P, et al. High-frequency Doppler US of the prostate: effect of patient position. Radiology. 2002;222:634–639. PubMed

Halpern EJ, Frauscher F, Strup SE, Nazarian LN, O'Kane P, Gomella LG. Prostate: high-frequency Doppler US imaging for cancer detection. Radiology. 2002;225:71–77. PubMed

Xie SW, Li HL, Du J, Guo YF, Xin M, Li FH. Contrast-enhanced ultrasonography with contrast-tuned imaging technology for the detection of prostate cancer: comparison with conventional ultrasonography. BJU Int. 2011;109:1620–1626. PubMed

Ives EP, Gomella LG, Halpern EJ. Effect of dutasteride therapy on Doppler US evaluation of prostate: preliminary results. Radiology. 2005;237:197–201. PubMed

Mitterberger M, Pinggera G, Horninger W, Strasser H, Halpern E, Pallwein L, et al. Dutasteride prior to contrast-enhanced colour Doppler ultrasound prostate biopsy increases prostate cancer detection. Eur Urol. 2008;53:112–117. PubMed

Mitterberger M, Pinggera GM, Pallwein L, Gradl J, Frauscher F, Bartsch G, et al. The value of three-dimensional transrectal ultrasonography in staging prostate cancer. BJU Int. 2007;100:47–50. PubMed

Sehgal CM, Broderick GA, Whittington R, Gorniak RJ, Arger PH. Three-dimensional US and volumetric assessment of the prostate. Radiology. 1994;192:274–278. PubMed

Krouskop TA, Wheeler TM, Kallel F, Garra BS, Hall T. Elastic moduli of breast and prostate tissues under compression. Ultrason Imaging. 1998;20:260–274. PubMed

Ophir J, Céspedes I, Ponnekanti H, Yazdi Y, Li X. Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging. 1991;13:111–134. PubMed

Konig K, Scheipers U, Pesavento A, Lorenz A, Ermert H, Senge T. Initial experiences with real-time elastography guided biopsies of the prostate. J Urol. 2005;174:115–117. PubMed

Pesavento APC, Krueger M, Ermert H. A time efficient and accurate strain estimation concept for ultrasonic elastography using interactive phase zero estimation. IEEE Trans Ultrason Ferroelect Freq Contr. 1999;46:1057–1067. PubMed

Ophir J, Miller RK, Ponnekanti H, Céspedes I, Whittaker AD. Elastography of beef muscle. Meat Sci. 1994;36:239–250. PubMed

Pallwein L, Aigner F, Faschingbauer R, Pallwein E, Pinggera G, Bartsch G, et al. Prostate cancer diagnosis: value of real-time elastography. Abdom Imaging. 2008;33:729–735. PubMed

Pallwein L, Mitterberger M, Gradl J, Aigner F, Horninger W, Strasser H, et al. Value of contrast-enhanced ultrasound and elastography in imaging of prostate cancer. Curr Opin Urol. 2007;17:39–47. PubMed

Aigner F, Pallwein L, Junker D, Schäfer G, Mikuz G, Pedross F, et al. Value of real-time elastography targeted biopsy for prostate cancer detection in men with prostate specific antigen 1.25 ng/ml or greater and 4.00 ng/ml or less. J Urol. 2010;184:913–917. PubMed

Pallwein L, Mitterberger M, Pinggera G, Aigner F, Pedross F, Gradl J, et al. Sonoelastography of the prostate: Comparison with systematic biopsy findings in 492 patients. Eur J Radiol. 2008;65:304–310. PubMed

Aboumarzouk OM, Ogston S, Huang Z, Melzer AEA, Stolzenberg JU, Nabi G. Diagnostic accuracy of transrectal elastosonography (TRES) imaging for the diagnosis of prostate cancer: a systematic review and meta-analysis. BJU Int. 2012;110:1414–1423. PubMed

Salomon G, Köllerman J, Thederan I, Chunk FK, Budäus L, et al. Evaluation of prostate cancer detection with ultrasound real-time elastography: a comparison with step section pathological analysis after radical prostatectomy. Eur Urol. 2008;54:1354–1362. PubMed

Sumura M, Shigeno K, Hyuga T, Yoneda T, Shiina H, Igawa M. Initial evaluation of prostate cancer with real-time elastography based on step-section pathologic analysis after radical prostatectomy: a preliminary study. Int J Urol. 2007;14:811–816. PubMed

Hricak H, Wang L, Wei DC, Coakley FV, Akin O, Reuter VE, et al. The role of preoperative endorectal MRI in the decision regarding whether to preserve or resect neurovascular bundles during radical retropubic prostatectomy. Cancer. 2004;100:2655–2663. PubMed

Sartor AO, Hricak H, Wheeler TM, Coleman J, Penson DF, Carrol PR, et al. Evaluating localized prostate cancer and identifying candidates for focal therapy. Urology. 2008;72(6) Suppl:12–23. PubMed

Aigner F, Pallwein L, Pelzer A, Schaefer G, Bartsch G, Nedden Dz, et al. Value of magnetic resonance imaging in prostate cancer diagnosis. World J Urol. 2007;25:351–359. PubMed

Moore CM, Robertson NL, Arsanious N, Middleton E, Villers A, Klotz L, et al. Image-guided prostate biopsy using magnetic resonance imaging-derived targets: a systematic review. Eur Urol. 2013;63:125–140. PubMed

Mozer P, Baumann M, Chevreau G, Moreau-Gaudry A, Bart S, RenardPenna R, et al. Mapping of transrectal ultrasonographic prostate biopsies: quality control and learning curve assessment by image processing. J Ultrasound Med. 2009;28:455–460. PubMed

Ukimura O, Desai MM, Palmer S, Valencerina S, Gross M, Abreau AL, et al. 3-Dimensional elastic registration system of prostate biopsy location by real-time 3-dimensional transrectal ultrasound guidance with magnetic resonance/transrectal ultrasound image fusion. J Urol. 2012;187:1080–1086. PubMed

Pinto PA, Chung PH, Rastinehad AR, Baccala AA, Jr, Kruecker J, Benjamin CJ, et al. Magnetic resonance imaging/ultrasound fusion guided prostate biopsy improves cancer detection following transrectal ultrasound biopsy and correlates with multiparametric magnetic resonance imaging. J Urol. 2011;186:1281–1285. PubMed PMC

Miyagawa T, Ishikawa S, Kimura T, Suetomi T, Tsutsumi M, Irie T, et al. Real-time Virtual Sonography for navigation during targeted prostate biopsy using magnetic resonance imaging data. Int J Urol. 2010;17:855–860. PubMed

Reynier C, Troccaz J, Fourneret P, Dusserre A, Gay-Jeune C, Descotes JL, et al. MRI/TRUS data fusion for prostate brachytherapy. Prelimenary results. Med Phys. 2004;31:1568–1575. PubMed

Fiard G, Hohn N, Descotes JL, Rambeaud JJ, Troccaz J, Long JA. Targeted MRI-guided prostate biopsies for the detection of prostate cancer: initial clinical experience with real-time 3-dimensional transrectal ultrasound guidance and magnetic resonance/transrectal ultrasound image fusion. Urology. 2013;81:1372–1378. PubMed

Barentsz JO, Richenberg J, Clements R, Choyke P, Verma S, Villeirs G, et al. ESUR prostate MR guidelines 2012. Eur Radiol. 2012;22:746–757. PubMed PMC

Fiard G, Hohn N, Descotes JL, Rambeaud JJ, Troccaz J, Targeted JA. MRI-guided prostate biopsies for the detection of prostate cancer: initial clinical experience with real-time 3-dimensional transrectal ultrasound guidance and magnetic resonance/transrectal ultrasound image fusion. Urology. 2013;81:1372–1378. PubMed