A positive real-time elastography is an independent marker for detection of high-risk prostate cancers in the primary biopsy setting




  • To evaluate the performance of real-time elastography (RTE) in an initial biopsy setting.

Patients and Methods

  • In the period from February 2011 to June 2012, 127 consecutive patients were included in the study.
  • We used a Hitachi Preirus with Hi-RTE module, a prostate end-fire transrectal probe was used for RTE and for targeted biopsies, and a simultaneous biplane probe was used for the standard systematic biopsies.
  • The peripheral zone of the prostate was divided into six regions, and each biopsy obtained was referred to a specific region.
  • All patients were first examined with RTE and, if cancer was suspected, targeted biopsies were taken. A standard systematic 10-core biopsy was then taken in all patients.


  • In all, 64 (50%) patients were diagnosed with prostate cancer in the initial biopsy setting. Three patients were diagnosed solely on RTE-targeted biopsies, 31 were found only in systematic biopsies, and 30 were correctly diagnosed with both methods.
  • In the RTE-positive group there was a significantly higher frequency of positive cores, a lower prostate volume, a higher Gleason score, and a higher fraction of cancer tissue in each core.
  • In a multiple regression model RTE was an independent marker for high-risk cancer.
  • The sensitivity of 42% for all prostate cancers increased to 60% for high-grade prostate cancers.
  • Similarly, the negative predictive value increased from 79% to 97%. An additional eight patients were diagnosed with prostate cancer during the study period.


  • A positive RTE is an independent marker for detection of high-risk prostate cancer, and a negative RTE argues against such.
  • RTE with targeted biopsies cannot replace systematic biopsies, but provides valuable additional information about the tumours.