The Role of Ultrasonography
The main diagnostic tools used to look for evidence of prostate cancer include digital rectal examination (DRE), serum concentration of prostate-specific antigen (PSA), and transrectal ultrasonography (TRUS)-guided biopsy [2]. In this chapter, we review t
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Suzanne van den Heuvel, Paul C.M.S. Verhagen, and Chris H. Bangma
Introduction Prostate cancer is the most common malignancy in the Western world, affecting approximately one in every six men. It is the second leading cause of cancer-related deaths in American men [1]. The main diagnostic tools used to look for evidence of prostate cancer include digital rectal examination (DRE), serum concentration of prostate-specific antigen (PSA), and transrectal ultrasonography (TRUS)-guided biopsy [2]. In this chapter, we review the clinical role for TRUS and recent ultrasonography developments in the detection and diagnosis of prostate disease.
History TRUS was initially used as a technique to evaluate rectal abnormalities, but in 1963, Takahashi et al. were the first to use this technique for evaluation of the prostate [3]. However, medical ultrasound was rather in an early phase at this time, so images created with this technique were of poor quality and they carried little medical utility [4]. The first clinically
S. van den Heuvel, M.D. (*) Department of Urology, Erasmus University Medical Centre Rotterdam, ‘s Gravendijkwal 230, Room H-187, Rotterdam 3015 CE, The Netherlands e-mail: [email protected] P.C.M.S. Verhagen Department of Urology, Erasmus University Medical Centre Rotterdam, ‘s Gravendijkwal 230, Room Hs 402, Rotterdam 3015 CE, The Netherlands e-mail: [email protected] C.H. Bangma, M.D., Ph.D. Department of Urology, Erasmus University Medical Centre, ‘s Gravendijkwal 230, Room H-1093, Rotterdam 3015 CE, The Netherlands e-mail: [email protected] A. Tewari (ed.), Prostate Cancer: A Comprehensive Perspective, DOI 10.1007/978-1-4471-2864-9_39, © Springer-Verlag London 2013
meaningful images of the prostate obtained with TRUS were described in 1974 by Watanabe et al. [5]. They used a 3.5MHz transducer, which was at that time considered to be state of the art, to detect abnormalities of the prostate and measure prostate size. As ultrasound technology has become more refined, the use of TRUS increased.
Conventional Gray-Scale Transrectal Ultrasonography TRUS has revolutionized our ability to examine the prostate. Today, it is the most commonly used modality to detect prostate pathology and to assess prostate volume [6]. Furthermore, TRUS has become a mainstay for imaging-guided prostate interventions, including prostate needle biopsies, brachytherapy, cryotherapy, and high-intensity focused ultrasound (HIFU) [7]. TRUS provides an excellent visualization of the prostate. Advantages of TRUS include the ability to direct the biopsy needle precisely into regions of interest or to provide a uniform spatial separation of biopsy cores [8]. For these reasons, most prostate biopsies are taken under TRUS guidance. The greatest challenge for TRUS, however, remains the early and valid detection of prostate cancer [9, 10]. TRUS is highly operator dependent and thus is unsuitable as a screening test. Even in experienced hands sensitivity and specificity to detect prostate cancer is only has high
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