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Neue Ultraschalltechnologien für die Diagnostik des Prostatakarzinoms

New ultrasound technologies for the diagnostics of prostate cancer

Der Radiologe volume 51, pages 938–946 (2011)Cite this article

Zusammenfassung

Klinisches/methodisches Problem

Das Prostatakarzinom ist der am häufigsten diagnostizierte Krebs bei Männern. Die derzeitige Diagnostik basiert auf 3 Säulen: prostataspezifisches Antigen, digital-rektale Untersuchung (DRU) und die TRUS-geführte systematische Biopsie. Diese Verfahren haben wesentliche Limitationen, welche in einer hohen Anzahl von unnötigen systematischen Biopsien resultiert. Diese sind mit einer Morbidität und Kosten verbunden.

Radiologische Standardverfahren

Die klassische B-Bild-Sonographie (transrektaler Ultraschall, TRUS) hat eine niedrige Sensitivität und Spezifität bei der Detektion des Prostatakarzinoms.

Methodische Innovationen

Neue Ultraschalltechnologien, einschließlich Farb- und Powerdopplersonographie, echosignalverstärkte Sonographie und Sonoelastographie haben eine Verbesserung bei der Detektion des Prostatakarzinoms nachgewiesen.

Leistungsfähigkeit

Die echosignalverstärkte Sonographie weist eine Sensitivität von 100% (95%-Konfidenzintervall, 95%) mit einem negativen Vorhersagewert (NPV) von 99,8% und einem positiven Vorhersagewert (PPV) von 88,8% bei der Prostatakarzinomdetektion auf. Die Echtzeitsonoelastographie zeigte Sensitivitäten von 86% bei Spezifitäten von 81% und einen NPV von 91% bei der Prostatakarzinomdetektion.

Bewertung

Die Mehrzahl der Studien zeigt, dass diese neuen Ultraschallverfahren eine 1,5- bis 2,5-fach höhere Prostatakarzinomdetektion pro Biopsiestanze erzielen. Leider liegen noch keine Multicenterstudienergebnisse vor, sind aber in Vorbereitung.

Empfehlung für die Praxis

Bei Patienten mit Verdacht auf ein Prostatakarzinom (erhöhtes PSA, suspekte DRU) sollen diese neuen Ultraschallverfahren eingesetzt werden, weil damit ein Prostatakarzinom erkannt werden kann und diese Verfahren eine gezielte Biopsie ermöglichen.

Abstract

Clinical/methodological issue

Prostate cancer is the most common cancer in men. The diagnosis is based on prostate-specific antigen (PSA), digital rectal examination (DRE) and transrectal ultrasound (TRUS) guided biopsy. These techniques have considerable limitations, which result in unnecessary biopsies. Furthermore the biopsies are associated with morbidity and costs.

Standard radiological methods

Standard gray-scale ultrasound has a low sensitivity and specificity for prostate cancer detection.

Methodological innovations

New ultrasound technologies, including color- and power Doppler ultrasound, contrast enhanced US and real-time sonoelastography have shown to improve prostate cancer diagnosis.

Performance

Contrast-enhanced ultrasound has shown a sensitivity of 100% (95% CI, 95%), a negative predictive value (NPV) of 99.8% and a positive predictive value (PPV) of 88.8% for prostate cancer detection. Real-time sonoelastography has shown a sensitivity of 86%, a specificity of 81% and NPV of 91% for prostate cancer diagnosis.

Achievements

Most studies show that these new ultrasound modalities demonstrate a 1.5 to 2.5 times higher detection of prostate cancer per biopsy specimen compared with systematic biopsy. Multicenter studies results are at present lacking but are, however ongoing.

Practical recommendations

In patients with suspected prostate cancer (elevated PSA, suspicious DRE) these new ultrasound techniques should be used. These techniques can detect prostate cancer and allow a targeted biopsy approach.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Consultant Bracco SpA (bis 2009).

Author information

Affiliations

  1. Department für Radiologie, Medizinische Universität Innsbruck, Anichstr. 35, A-6020, Innsbruck, Österreich

    T. de Zordo, W. Jaschke, F. Aigner &  F. Frauscher

  2. Department für Urologie, Medizinische Universität Innsbruck, Innsbruck, Österreich

    M. Ladurner & W. Horninger

  3. Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, Niederlande

    S.W. Heijmink

Authors
  1. T. de Zordo
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  2. M. Ladurner
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  3. W. Horninger
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  4. S.W. Heijmink
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  5. W. Jaschke
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  6. F. Aigner
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  7. F. Frauscher
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Corresponding author

Correspondence to F. Frauscher.

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de Zordo, T., Ladurner, M., Horninger, W. et al. Neue Ultraschalltechnologien für die Diagnostik des Prostatakarzinoms. Radiologe 51, 938–946 (2011). https://doi.org/10.1007/s00117-011-2178-y

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Schlüsselwörter

  • Sättigungsbiopsie
  • Powerdoppler
  • Sonoelastographie
  • Biopsie
  • Tumorvaskularisation

Keywords

  • Saturation biopsy
  • Power Doppler
  • Elastography
  • Biopsy
  • Tumor vascularization