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Novel non-MRI imaging techniques for primary diagnosis of prostate cancer: micro-ultrasound, contrast-enhanced ultrasound, elastography, multiparametric ultrasound, and PSMA PET/CT

Prostate Cancer and Prostatic Diseases volume 27, pages 29–36 (2024)Cite this article

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Abstract

Background

Multiparametric magnetic resonance imaging (mpMRI) provides enhanced diagnostic accuracy in the detection of prostate cancer, but is not devoid of limitations. Given the recent evolution of non-MRI imaging techniques, this critical review of the literature aimed at summarizing the available evidence on ultrasound-based and nuclear medicine imaging technologies in the initial diagnosis of PCa.

Methods

Three databases (PubMed®, Web of Science™, and Scopus®) were queried for studies examining their diagnostic performance in the primary diagnosis of PCa, weighted against a histological confirmation of PCa diagnosis, using a free-text protocol. Retrospective and prospective studies, both comparative and non-comparative, systematic reviews (SR) and meta-analysis (MA) were included. Based on authors’ expert opinion, studies were selected, data extracted, and results qualitatively described.

Results

Micro-ultrasound (micro-US) appears as an appealing diagnostic strategy given its high accuracy in detection of PCa, apparently non-inferior to mpMRI. The use of multiparametric US (mpUS) likely gives an advantage in terms of effectiveness coming from the combination of different modalities, especially when certain modalities are combined. Prostate-specific membrane antigen (PSMA) PET/CT may represent a whole-body, one-step approach for appropriate diagnosis and staging of PCa. The direct relationship between lesions avidity of radiotracers and histopathologic and prognostic features, and its valid diagnostic performance represents appealing characteristics. However, intrinsic limits of each of these techniques exist and further research is needed before definitively considering them reliable tools for accurate PCa diagnosis. Other novel technologies, such as elastography and multiparametric US, currently relies on a limited number of studies, and therefore evidence about them remains preliminary.

Conclusion

Evidence on the role of non-MRI imaging options in the primary diagnosis of PCa is steadily building up. This testifies a growing interest towards novel technologies that might allow overcoming some of the limitations of current gold standard MRI imaging.

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Authors and Affiliations

  1. Department of Urology, Rush University Medical Center, Chicago, IL, USA

    Francesco Ditonno, Antonio Franco, Celeste Manfredi, Lucas B. Zukowski, Srinivas Vourganti & Riccardo Autorino

  2. Department of Urology, University of Verona, Verona, Italy

    Francesco Ditonno, Alessandro Veccia & Alessandro Antonelli

  3. Department of Urology, Sant’Andrea Hospital, La Sapienza University, Rome, Italy

    Antonio Franco & Cosimo De Nunzio

  4. Urology Unit, Department of Woman, Child and General and Specialized Surgery, “Luigi Vanvitelli” University, Naples, Italy

    Celeste Manfredi

  5. Urology Department, Lausanne University Hospital, Lausanne, Switzerland

    Massimo Valerio

  6. Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Laura Bukavina

  7. Department of Urology, University Hospital Tuebingen, Tuebingen, Germany

    Arnuf Stenzl

  8. Johns Hopkins Medicine, Sibley Memorial Hospital, Washington, DC, USA

    Gerald L. Andriole

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Ditonno, F., Franco, A., Manfredi, C. et al. Novel non-MRI imaging techniques for primary diagnosis of prostate cancer: micro-ultrasound, contrast-enhanced ultrasound, elastography, multiparametric ultrasound, and PSMA PET/CT. Prostate Cancer Prostatic Dis 27, 29–36 (2024). https://doi.org/10.1038/s41391-023-00708-9

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