Skip to main content
SpringerLink
Log in

Sonographie der Prostata

Stellenwert für den Urologen in Klinik und Praxis

Sonography of the prostate

Relevance for urologists in daily clinical routine

  • Leitthema
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Trotz der kontinuierlichen Weiterentwicklung des transrektalen Ultraschalls (TRUS) und der Kombination verschiedener Bildgebungsmodalitäten gibt es aktuell noch kein Verfahren, das die systematische Biopsie der Prostata obsolet macht und eine alleinige läsionsgesteuerte Biopsie zulässt. Durch die Weiterentwicklung des konventionellen TRUS durch höhere Schallfrequenzen sowie die Kombination verschiedener Ultraschallmodalitäten (z. B. der Scherwellenelastographie und dem kontrastmittelgestütztem Ultraschall) rückt der transrektale Ultraschall zur Diagnostik des Prostatakarzinoms wieder zunehmend in den Fokus. Aktuell hat jedoch die multiparametrisch magnetresonanztomographisch (mpMRT) gestützte Target-Biopsie zusammen mit der systematischen Biopsie die beste Datenlage bezüglich einer Verbesserung der Detektionsrate von klinisch signifikantem Prostatakrebs im Vergleich zur alleinigen randomisierten Biopsie. Bezüglich des Biopsiezugangs wird voraussichtlich die transrektale Biopsie durch den transperinealen Zugang immer mehr in den Hintergrund geraten. Der TRUS wird jedoch in beiden Zugangswegen verwendet, weswegen von einer fortschreitenden Weiterentwicklung auszugehen ist.

Abstract

Despite the continuous technical progress regarding the transrectal ultrasonography of the prostate (TRUS) and its successful use in combination with magnetic resonance imaging (MRI) in MRI-targeted biopsy, there is no radiologic modality being able to rule out clinically significant prostate cancer without the need of systematic biopsy. In the past few years, TRUS regained more attention due to the development of high frequency ultrasound as well as the combination of different ultrasonic modalities like shear wave elastography and contrast-enhanced sonography (CEUS). Currently, multiparametric MRI (mpMRI)-targeted biopsy shows the best results concerning detection rates, sensitivity and specificity of clinically significant prostate cancer compared to systematic biopsy. In the future, transperineal biopsy is probably going to increasingly replace the transrectal biopsy approach. For both approaches, transrectal ultrasonography is necessary to display the prostate and to detect suspicious lesions. Therefore future improvements in transrectal ultrasonography can be expected.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Norberg M, Egevad L, Holmberg L, Sparén P, Norlén BJ, Busch C (1997) The sextant protocol for ultrasound-guided core biopsies of the prostate underestimates the presence of cancer. Urology 50(4):562–566

    Article  CAS  PubMed  Google Scholar 

  2. Beerlage HP, Aarnink RG, Ruijter E, Witjes JA, Wijkstra H, Van De Kaa CA, Debruyne FJ, De La Rosette J (2001) Correlation of transrectal ultrasound, computer analysis of transrectal ultrasound and histopathology of radical prostatectomy specimen. Prostate Cancer Prostatic Dis 4(1):56–62

    Article  CAS  PubMed  Google Scholar 

  3. Cheng S, Rifkin MD (2001) Color Doppler imaging of the prostate: important adjunct to endorectal ultrasound of the prostate in the diagnosis of prostate cancer. Ultrasound Q 17(3):185–189. https://doi.org/10.1097/00013644-200109000-00008

    Article  CAS  PubMed  Google Scholar 

  4. Lee HY, Lee HJ, Byun SS, Lee SE, Hong SK, Kim SH (2009) Classification of focal prostatic lesions on transrectal ultrasound (TRUS) and the accuracy of TRUS to diagnose prostate cancer. Korean J Radiol 10(3):244–251

    Article  PubMed  PubMed Central  Google Scholar 

  5. Tamsel S, Killi R, Hekimgil M, Altay B, Soydan S, Demirpolat G (2008) Transrectal ultrasound in detecting prostate cancer compared with serum total prostate-specific antigen levels. J Med Imaging Radiation Oncol 52(1):24–28

    Article  CAS  Google Scholar 

  6. Halpern EJ, Strup SE (2000) Using gray-scale and color and power Doppler sonography to detect prostatic cancer. AJR Am J Roentgenol 174(3):623–627

    Article  CAS  PubMed  Google Scholar 

  7. Grummet J, Gorin MA, Popert R, O’Brien T, Lamb AD, Hadaschik B, Radtke JP, Wagenlehner F, Baco E, Moore CM, Emberton M, George AK, Davis JW, Szabo RJ, Buckley R, Loblaw A, Allaway M, Kastner C, Briers E, Royce PL, Frydenberg M, Murphy DG, Woo HH (2020) „TREXIT 2020“: why the time to abandon transrectal prostate biopsy starts now. Prostate Cancer Prostatic Dis 23(1):62–65

    Article  PubMed  PubMed Central  Google Scholar 

  8. Correas JM, Halpern EJ, Barr RG, Ghai S, Walz J, Bodard S, Dariane C, de la Rosette J (2021) Advanced ultrasound in the diagnosis of prostate cancer. World J Urol 39(3):661–676

    Article  PubMed  Google Scholar 

  9. Yunkai Z, Yaqing C, Jun J, Tingyue Q, Weiyong L, Yuehong Q, Wenbin G, Lifeng W, Jun Q (2019) Comparison of contrast-enhanced ultrasound targeted biopsy versus standard systematic biopsy for clinically significant prostate cancer detection: results of a prospective cohort study with 1024 patients. World J Urol 37(5):805–811

    Article  PubMed  Google Scholar 

  10. Li Y, Tang J, Fei X, Gao Y (2013) Diagnostic performance of contrast enhanced ultrasound in patients with prostate cancer: a meta-analysis. Acad Radiol 20(2):156–164

    Article  PubMed  Google Scholar 

  11. Postema AW, Frinking PJ, Smeenge M, De Reijke TM, De la Rosette JJ, Tranquart F, Wijkstra H (2016) Dynamic contrast-enhanced ultrasound parametric imaging for the detection of prostate cancer. BJU Int 117(4):598–603

    Article  PubMed  Google Scholar 

  12. Apfelbeck M, Clevert DA, Ricke J, Stief C, Schlenker B (2018) Contrast enhanced ultrasound (CEUS) with MRI image fusion for monitoring focal therapy of prostate cancer with high intensity focused ultrasound (HIFU)1. Clin Hemorheol Microcirc 69(1–2):93–100

    Article  CAS  PubMed  Google Scholar 

  13. Apfelbeck M, Chaloupka M, Schlenker B, Stief CG, Clevert DA (2019) Follow-up after focal therapy of the prostate with high intensity focused ultrasound (HIFU) using contrast enhanced ultrasound (CEUS) in combination with MRI image fusion. Clin Hemorheol Microcirc 73(1):135–143

    Article  CAS  PubMed  Google Scholar 

  14. Colleselli D, Bektic J, Schaefer G, Frauscher F, Mitterberger M, Brunner A, Schwentner C, Bartsch G, Horninger W, Pelzer AE (2007) The influence of prostate volume on prostate cancer detection using a combined approach of contrast-enhanced ultrasonography-targeted and systematic grey-scale biopsy. BJU Int 100(6):1264–1267

    Article  PubMed  Google Scholar 

  15. Aigner F, Pallwein L, Mitterberger M, Pinggera GM, Mikuz G, Horninger W, Frauscher F (2009) Contrast-enhanced ultrasonography using cadence-contrast pulse sequencing technology for targeted biopsy of the prostate. BJU Int 103(4):458–463

    Article  PubMed  Google Scholar 

  16. Tang J, Yang JC, Li Y, Li J, Shi H (2007) Peripheral zone hypoechoic lesions of the prostate: evaluation with contrast-enhanced gray scale transrectal ultrasonography. J Ultrasound Med 26(12):1671–1679

    Article  PubMed  Google Scholar 

  17. Taymoorian K, Thomas A, Slowinski T, Khiabanchian M, Stephan C, Lein M, Deger S, Lenk S, Loening SA, Fischer T (2007) Transrectal broadband-Doppler sonography with intravenous contrast medium administration for prostate imaging and biopsy in men with an elevated PSA value and previous negative biopsies. Anticancer Res 27(6c):4315–4320

    PubMed  Google Scholar 

  18. Yang JC, Tang J, Li J, Luo Y, Li Y, Shi H (2008) Contrast-enhanced gray-scale transrectal ultrasound-guided prostate biopsy in men with elevated serum prostate-specific antigen levels. Acad Radiol 15(10):1291–1297

    Article  PubMed  Google Scholar 

  19. Mottet N, van den Bergh RCN, Briers E, Van den Broeck T, Cumberbatch MG, De Santis M, Fanti S, Fossati N, Gandaglia G, Gillessen S, Grivas N, Grummet J, Henry AM, van der Kwast TH, Lam TB, Lardas M, Liew M, Mason MD, Moris L, Oprea-Lager DE, van der Poel HG, Rouvière O, Schoots IG, Tilki D, Wiegel T, Willemse PM, Cornford P (2021) EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer-2020 update. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 79(2):243–262

    Article  CAS  PubMed  Google Scholar 

  20. Ukimura O, Coleman JA, de la Taille A, Emberton M, Epstein JI, Freedland SJ, Giannarini G, Kibel AS, Montironi R, Ploussard G, Roobol MJ, Scattoni V, Jones JS (2013) Contemporary role of systematic prostate biopsies: indications, techniques, and implications for patient care. Eur Urol 63(2):214–230

    Article  PubMed  Google Scholar 

  21. Fütterer JJ, Briganti A, De Visschere P, Emberton M, Giannarini G, Kirkham A, Taneja SS, Thoeny H, Villeirs G, Villers A (2015) Can clinically significant prostate cancer be detected with multiparametric magnetic resonance imaging? A systematic review of the literature. Eur Urol 68(6):1045–1053

    Article  PubMed  Google Scholar 

  22. Drost FH, Osses DF, Nieboer D, Steyerberg EW, Bangma CH, Roobol MJ, Schoots IG (2019) Prostate MRI, with or without MRI-targeted biopsy, and systematic biopsy for detecting prostate cancer. Cochrane Database Syst Rev 4(4):CD12663

    PubMed  Google Scholar 

  23. Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, Margolis D, Schnall MD, Shtern F, Tempany CM, Thoeny HC, Verma S (2016) PI-RADS prostate imaging—reporting and data system: 2015, version 2. Eur Urol 69(1):16–40

    Article  PubMed  Google Scholar 

  24. Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft DK, AWMF) (2021) Interdisziplinäre Leitlinie der Qualität S3 zur Früherkennung, Diagnose und Therapie der verschiedenen Stadien des Prostatakarzinoms, Langversion 6.2. http://www.leitlinienprogramm-onkologie.de/leitlinien/prostatakarzinom/. Zugegriffen: 9. Jan. 2022

  25. Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH, Briganti A, Budäus L, Hellawell G, Hindley RG, Roobol MJ, Eggener S, Ghei M, Villers A, Bladou F, Villeirs GM, Virdi J, Boxler S, Robert G, Singh PB, Venderink W, Hadaschik BA, Ruffion A, Hu JC, Margolis D, Crouzet S, Klotz L, Taneja SS, Pinto P, Gill I, Allen C, Giganti F, Freeman A, Morris S, Punwani S, Williams NR, Brew-Graves C, Deeks J, Takwoingi Y, Emberton M, Moore CM (2018) MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 378(19):1767–1777

    Article  PubMed  PubMed Central  Google Scholar 

  26. van der Leest M, Cornel E, Israël B, Hendriks R, Padhani AR, Hoogenboom M, Zamecnik P, Bakker D, Setiasti AY, Veltman J, van den Hout H, van der Lelij H, van Oort I, Klaver S, Debruyne F, Sedelaar M, Hannink G, Rovers M, Hulsbergen-van de Kaa C, Barentsz JO (2019) Head-to-head comparison of transrectal ultrasound-guided prostate biopsy versus multiparametric prostate resonance imaging with subsequent magnetic resonance-guided biopsy in biopsy-naïve men with elevated prostate-specific antigen: a large prospective multicenter clinical study. Eur Urol 75(4):570–578

    Article  PubMed  Google Scholar 

  27. Rouvière O, Puech P, Renard-Penna R, Claudon M, Roy C, Mège-Lechevallier F, Decaussin-Petrucci M, Dubreuil-Chambardel M, Magaud L, Remontet L, Ruffion A, Colombel M, Crouzet S, Schott AM, Lemaitre L, Rabilloud M, Grenier N (2019) Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study. Lancet Oncol 20(1):100–109

    Article  PubMed  Google Scholar 

  28. Wegelin O, Exterkate L, van der Leest M, Kummer JA, Vreuls W, de Bruin PC, Bosch J, Barentsz JO, Somford DM, van Melick HHE (2019) The FUTURE trial: a multicenter randomised controlled trial on target biopsy techniques based on magnetic resonance imaging in the diagnosis of prostate cancer in patients with prior negative biopsies. Eur Urol 75(4):582–590

    Article  PubMed  Google Scholar 

  29. Johnson DC, Raman SS, Mirak SA, Kwan L, Bajgiran AM, Hsu W, Maehara CK, Ahuja P, Faiena I, Pooli A, Salmasi A, Sisk A, Felker ER, Lu DSK, Reiter RE (2019) Detection of individual prostate cancer foci via multiparametric magnetic resonance imaging. Eur Urol 75(5):712–720

    Article  CAS  PubMed  Google Scholar 

  30. Klotz L, Lughezzani G, Maffei D, Sánchez A, Pereira JG, Staerman F, Cash H, Luger F, Lopez L, Sanchez-Salas R, Abouassaly R, Shore ND, Eure G, Paciotti M, Astobieta A, Wiemer L, Hofbauer S, Heckmann R, Gusenleitner A, Kaar J, Mayr C, Loidl W, Rouffilange J, Gaston R, Cathelineau X, Klein E (2021) Comparison of micro-ultrasound and multiparametric magnetic resonance imaging for prostate cancer: a multicenter, prospective analysis. Can Urol Assoc J 15(1):E11–e16

    PubMed  Google Scholar 

  31. Lughezzani G, Maffei D, Saita A, Paciotti M, Diana P, Buffi NM, Colombo P, Elefante GM, Hurle R, Lazzeri M, Guazzoni G, Casale P (2021) Diagnostic accuracy of microultrasound in patients with a suspicion of prostate cancer at magnetic resonance imaging: a single-institutional prospective study. Eur Urol Focus 7(5):1019–1026

    Article  PubMed  Google Scholar 

  32. Sountoulides P, Pyrgidis N, Polyzos SA, Mykoniatis I, Asouhidou E, Papatsoris A, Dellis A, Anastasiadis A, Lusuardi L, Hatzichristou D (2021) Micro-ultrasound-guided vs multiparametric magnetic resonance imaging-targeted biopsy in the detection of prostate cancer: a systematic review and meta-analysis. J Urol 205(5):1254–1262

    Article  PubMed  Google Scholar 

  33. Ghai S, Eure G, Fradet V, Hyndman ME, McGrath T, Wodlinger B, Pavlovich CP (2016) Assessing cancer risk on novel 29 MHz micro-ultrasound images of the prostate: creation of the micro-ultrasound protocol for prostate risk identification. J Urol 196(2):562–569

    Article  PubMed  Google Scholar 

  34. Luger F, Gusenleitner A, Kaar J, Mayr C, Loidl W (2019) Does 29 Mhz micro-ultrasound provide uniform diagnostic accuracy within and beyond the peripheral zone. Ann Urol Nehrol. https://doi.org/10.33552/AUN.2019.01.000519

    Article  Google Scholar 

  35. Abouassaly R, Klein EA, El-Shefai A, Stephenson A (2020) Impact of using 29 MHz high-resolution micro-ultrasound in real-time targeting of transrectal prostate biopsies: initial experience. World J Urol 38(5):1201–1206

    Article  PubMed  Google Scholar 

  36. Barr RG, Cosgrove D, Brock M, Cantisani V, Correas JM, Postema AW, Salomon G, Tsutsumi M, Xu HX, Dietrich CF (2017) WFUMB guidelines and recommendations on the clinical use of ultrasound elastography: part 5. Prostate. Ultrasound Med Biol 43(1):27–48

    Article  PubMed  Google Scholar 

  37. Kamoi K, Okihara K, Ochiai A, Ukimura O, Mizutani Y, Kawauchi A, Miki T (2008) The utility of transrectal real-time elastography in the diagnosis of prostate cancer. Ultrasound Med Biol 34(7):1025–1032

    Article  PubMed  Google Scholar 

  38. König K, Scheipers U, Pesavento A, Lorenz A, Ermert H, Senge T (2005) Initial experiences with real-time elastography guided biopsies of the prostate. J Urol 174(1):115–117

    Article  PubMed  Google Scholar 

  39. Miyagawa T, Tsutsumi M, Matsumura T, Kawazoe N, Ishikawa S, Shimokama T, Miyanaga N, Akaza H (2009) Real-time elastography for the diagnosis of prostate cancer: evaluation of elastographic moving images. Jpn J Clin Oncol 39(6):394–398

    Article  PubMed  Google Scholar 

  40. Nelson ED, Slotoroff CB, Gomella LG, Halpern EJ (2007) Targeted biopsy of the prostate: the impact of color Doppler imaging and elastography on prostate cancer detection and Gleason score. Urology 70(6):1136–1140

    Article  PubMed  Google Scholar 

  41. Salomon G, Köllerman J, Thederan I, Chun FK, Budäus L, Schlomm T, Isbarn H, Heinzer H, Huland H, Graefen M (2008) Evaluation of prostate cancer detection with ultrasound real-time elastography: a comparison with step section pathological analysis after radical prostatectomy. Eur Urol 54(6):1354–1362

    Article  PubMed  Google Scholar 

  42. Tsutsumi M, Miyagawa T, Matsumura T, Kawazoe N, Ishikawa S, Shimokama T, Shiina T, Miyanaga N, Akaza H (2007) The impact of real-time tissue elasticity imaging (elastography) on the detection of prostate cancer: clinicopathological analysis. Int J Clin Oncol 12(4):250–255

    Article  PubMed  Google Scholar 

  43. Anbarasan T, Wei C, Bamber JC, Barr RG, Nabi G (2021) Characterisation of prostate lesions using transrectal shear wave elastography (SWE) ultrasound imaging: a systematic review. Cancers (Basel) 13(1):122. https://doi.org/10.3390/cancers13010122

    Article  Google Scholar 

  44. Correas J‑M, Tissier A‑M, Khairoune A, Vassiliu V, Méjean A, Hélénon O, Memo R, Barr RG (2015) Prostate cancer: diagnostic performance of real-time shear-wave elastography. Radiology 275(1):280–289

    Article  PubMed  Google Scholar 

  45. Woo S, Kim SY, Cho JY, Kim SH (2014) Shear wave elastography for detection of prostate cancer: a preliminary study. Korean J Radiol 15(3):346–355

    Article  PubMed  PubMed Central  Google Scholar 

  46. Woo S, Kim SY, Lee MS, Cho JY, Kim SH (2015) Shear wave elastography assessment in the prostate: an intraobserver reproducibility study. Clin Imaging 39(3):484–487

    Article  PubMed  Google Scholar 

  47. Xiang L‑H, Fang Y, Wan J, Xu G, Yao M‑H, Ding S‑S, Liu H, Wu R (2019) Shear-wave elastography: role in clinically significant prostate cancer with false-negative magnetic resonance imaging. Eur Radiol 29(12):6682–6689

    Article  PubMed  Google Scholar 

  48. Wildeboer RR, Mannaerts CK, van Sloun RJG, Budäus L, Tilki D, Wijkstra H, Salomon G, Mischi M (2020) Automated multiparametric localization of prostate cancer based on B‑mode, shear-wave elastography, and contrast-enhanced ultrasound radiomics. Eur Radiol 30(2):806–815

    Article  PubMed  Google Scholar 

  49. Zhang M, Tang J, Luo Y, Wang Y, Wu M, Memmott B, Gao J (2019) Diagnostic performance of multiparametric transrectal ultrasound in localized prostate cancer: a comparative study with magnetic resonance imaging. J Ultrasound Med 38(7):1823–1830

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Urologische Klinik und Poliklinik des LMU Klinikums, Campus Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland

    Maria Apfelbeck, Christian G. Stief & Michael Chaloupka

  2. Klinik und Poliklinik für Radiologie des LMU Klinikums, Campus Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland

    Dirk-André Clevert

Authors
  1. Maria Apfelbeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dirk-André Clevert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christian G. Stief
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael Chaloupka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maria Apfelbeck.

Ethics declarations

Interessenkonflikt

M. Apfelbeck, D.-A. Clevert, C.G. Stief und M. Chaloupka geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Apfelbeck, M., Clevert, DA., Stief, C.G. et al. Sonographie der Prostata. Urologe 61, 365–373 (2022). https://doi.org/10.1007/s00120-022-01767-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-022-01767-x

Schlüsselwörter

Keywords

Search

Navigation