Biparametric MRI and Strain Elastography for Improving Cognitive Targeting in Prostate Cancer Detection

Biparametric MRI and Strain Elastography for Improving Cognitive Targeting in Prostate Cancer Detection | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Biparametric MRI and Strain Elastography for Improving Cognitive Targeting in Prostate Cancer Detection Dr Akshay Patil, Dr Anand Venugopal This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6090487/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : One of the most prevalent cancers in males is prostate cancer, which can be difficult to diagnose because of its ambiguous early signs. Aiming to improve detection accuracy, transrectal ultrasonography (TRUS) in conjunction with strain elastography and biparametric MRI (bpMRI) is an emerging diagnostic approach. Methods : A tertiary centre in coastal region of Karnatakacarried out this retrospective analysis between March 2022 and December 2024. Thirty-two male patients, ages 45 to 85, whose digital rectal examination revealed palpable anomalies or elevated PSA levels were included in the study. For the assessment of prostate lesions, patients underwent both bpMRI and TRUS/strain elastography. Histopathology results were used as the reference standard to compare the diagnostic performance of these modalities. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were all included in the data analysis. Results : Of the 32 cases, 56.25% were diagnosed as malignant and 43.75% as benign. The sensitivity and specificity for TRUS/strain elastography were 94.44% and 50%, respectively, compared to 76.47% and 53.33% for bpMRI. Combining both modalities improved specificity to 76.67%. Lesions classified as PI-RADS 4 on bpMRI were the most common in clinically insignificant cancer, while PI-RADS 5 lesions were predominant in clinically significant cases. Conclusion: TRUS/strain elastography demonstrated superior sensitivity compared to bpMRI in detecting prostate cancer. However, bpMRI contributed to better specificity, especially when combined with TRUS/strain elastography. This combined approach provides a promising method for improving the cognitive targeting of prostate cancer lesions, especially in clinically significant cases. Urology & Nephrology Biparametric MRI Prostate cancer Strain elastography Introduction Prostate cancer is one of the commonest types of cancer affecting men worldwide. It is the third leading cause of death, the first two being lung cancer and colorectal cancer. Prostate cancer does not lead to death by itself, instead death commonly is caused by the metastases to the brain, rectum, spinal cord, bladder or bones (1). The prostate is cone shaped and located within the sub-peritoneal region. It is situated between the rectum and pubic symphysis. The peripheral zone (PZ) is the largest of the four zones that make up the prostate. The remaining areas are the anterior fibromuscular stroma, transition zone (TZ), and central zone (CZ), which contains 25% of the glandular tissue (2). Prostate cancer instances can arise from PZ in up to 70% of cases, TZ in 20%, and CZ in just 1% of cases (3). Since localized prostate cancer lesions rarely cause symptoms, it might be challenging to identify them until the disease has progressed to an advanced stage (4). Numerous symptoms, such as increased frequency of urination, incontinence, and nocturia, may be brought on by different prostate illnesses, such as benign prostatic hyperplasia (BPH). Therefore, screening becomes extremely important (4). Increased level of serum prostate-specific antigen (PSA) was the test used for screening for prostate cancer. Due to its lack of specificity, PSA levels might rise with increasing physical activity, comparable circumstances, and other prostatic diseases including prostatitis or BPH (4). Strain Elastography is a technique that dynamically estimates the stiffness of the tissue by applying an external force and measuring the degree of distortion. As cancerous tissue has greater stiffness as compared to the normal tissue and the tissue of benign lesions, therefore, this technique has been used to differentiate malignant lesions in liver, breast, thyroid and cervix. Recent studies have demonstrated its utility in diagnosing prostate cancer (5). In biparametric MRI, mainly two types of sequences are used. These include: T2W and DWI with ADC. It does not use any type of contrast agent. Therefore, it has shorter acquisition time, is less expensive, has lower risk of allergic reactions and is safe for use in patients with medical conditions resulting in contradictions to the use of contrast (6). Materials and Methods This retrospective analysis was conducted from March 2022 to December 2024 in a tertiary care hospital in the coastal region of Karnataka, with ethical approval obtained from the Institutional Ethics Committee. In order to identify prostate cancer, the study sought to assess the diagnostic performance of transrectal ultrasonography (TRUS) with strain elastography and biparametric MRI. The study comprised the medical records of 32 male patients, ranging in age from 45 to 85, who had anomalies found during digital rectal examination (DRE) or had increased PSA values (> 4.0 ng/dL). The investigation did not include patients having a history of radiation therapy, hormone therapy, prostate procedures, or inflammatory bowel disease. Biparametric MRI and TRUS with strain elastography results were among the patient data that were retrospectively examined from hospital records. A 1.5 T MRI scanner (Achieva Philips) was used for MRI scans, and a Samsung RS80 evo was used for TRUS and elastography. Prior to imaging, bowel preparation and antibiotic prophylaxis were administered to every patient. TRUS-guided biopsies were carried out utilizing 12-core samples in addition to extra targeted biopsies from worrisome lesions found by imaging. Biparametric MRI sequences included diffusion-weighted imaging (DWI) and T2-weighted imaging (TWI) without the need for contrast materials. Tissue stiffness was evaluated using TRUS elastography, where soft (benign) and stiff (malignant) tissues were distinguished on color-coded maps. Under TRUS supervision, targeted biopsies were carried out using an 18G semiautomated biopsy needle, and biopsy samples were sent for histological analysis. Results The mean age of the study population was 68.69 ± 8.32 years, with the majority (40.62%) of cases falling in the 66–75 age group. Malignancy was seen in 56.25% of cases (18/32), while 43.75% (14/32) were benign. There was no statistically significant difference in the mean age between benign and malignant cases (P = 0.226). The age distribution showed that prostate cancer predominantly affected men above 65 years. The mean prostate volume for the cohort was 45.44 ± 23.03 cc. Although patients with benign conditions had a higher average prostate volume (53.64 ± 25.68 cc) compared to those with malignancy (39.06 ± 19.09 cc), the difference was not statistically significant (P = 0.075). The mean PSA level in the study population was 22.65 ± 24.70 ng/mL, with no significant difference between benign and malignant cases (P = 0.358). Biparametric MRI categorized patients using the PI-RADS scoring system, with most patients falling into the PI-RADS 4 category (53.12%). There was no significant difference in PI-RADS scoring between benign and malignant lesions (P = 0.441). However, further stratification revealed that PI-RADS 5 was associated with clinically significant prostate cancer, particularly in cases where the Gleason score was ≥ 7. Meanwhile, PI-RADS 3 and 4 were more commonly seen in benign and clinically insignificant cancers. Strain elastography showed that tissue stiffness (blue areas) was a strong indicator of malignancy. A total of 75% of cases had stiff areas, with 94.44% of these cases being malignant. Conversely, softer regions (red areas) were only present in benign cases (14.29%) and were absent in malignant ones. The difference in tissue stiffness between malignant and benign cases was statistically significant (P = 0.015). This suggests that TRUS/strain elastography is highly effective in distinguishing malignant from benign lesions based on tissue hardness. When evaluating the performance of TRUS/strain elastography and biparametric MRI for the detection of prostate cancer, TRUS/strain elastography showed a higher sensitivity (94.44%) compared to biparametric MRI (76.47%). However, biparametric MRI had slightly higher specificity (53.33%) compared to TRUS/strain elastography (50%). Combining both techniques resulted in a moderate diagnostic accuracy, with a sensitivity of 72.22% and specificity of 76.67%. This suggests that using both modalities together may enhance diagnostic accuracy, particularly for detecting clinically significant prostate cancer. Discussion Prostate Ca is the third most prevalent cancer affecting males. The gold standard for diagnosis is systematic biopsy and histologic examination. But it is invasive, and the lesion may be missed on biopsy. Non-invasive techniques like DRE and ultrasound have lower sensitivity and specificity. Therefore, the present study was conducted to evaluate the efficacy of TRUS/Strain elastography and biparametric MRI in detection of prostate cancer. Strain elastography demonstrated high sensitivity (94.44%) in detecting malignancy, with stiffer (blue) regions strongly associated with cancer. This finding aligns with the known increased stiffness of malignant tissue, making strain elastography a valuable non-invasive diagnostic tool. In study by Mahajan M. et al, they evaluated strain elastography for the diagnosis of prostate cancer. They observed that the sensitivity of strain elastography was 85.7%, specificity was 94.4%, PPV was 85.7% and NPV was 94.4% (7). Biparametric MRI, while slightly less sensitive, provided detailed anatomical information. Most clinically significant cancers (Gleason score ≥ 7) were categorized as PI-RADS 5, confirming MRI’s utility in detecting more aggressive cancers. Although MRI had lower sensitivity than elastography, its specificity was marginally higher. In the study by Kobilnyk Y. et al, they observed that most of the cases with clinically significant cancer had PI-RADS 4 and 5 (69.2%) as compared to 33.3% cases with clinically insignificant cancer having PI-RADS 4 and there was no case having PI-RADS 5 (8). When both modalities were combined, the diagnostic performance improved, yielding a sensitivity of 72.22% and a specificity of 76.67%. This demonstrates that a combined approach can enhance the detection of clinically significant prostate cancer, reducing missed diagnoses and unnecessary biopsies. In the study by Kothapalli J. and Peddi R., they evaluated the combined efficacy of mpMRI with elastography. They observed that the combined sensitivity for detection of prostate cancer was 84.5% and specificity was 82% (9). Conclusion The combination of TRUS/strain elastography and biparametric MRI enhances the accuracy of prostate cancer detection, offering a more comprehensive diagnostic tool that could improve patient outcomes while minimizing unnecessary interventions. References Schatten H. Brief Overview of Prostate Cancer Statistics, Grading, Diagnosis and Treatment Strategies. Adv Exp Med Biol. 2018; 1095:1-14. Yacoub JH, Oto A. MR Imaging of Prostate Zonal Anatomy. Radiol Clin North Am. 2018 Mar;56(2):197-209. McNeal JE, Redwine EA, Freiha FS, Stamey TA. Zonal distribution of prostatic adenocarcinoma. Correlation with histologic pattern and direction of spread. Am J Surg Pathol. 1988 Dec;12(12):897-906. Carlsson SV, Vickers AJ. Screening for Prostate Cancer. Med Clin North Am. 2020 Nov;104(6):1051-1062. Pallwein L, Mitterberger M, Struve P, Pinggera G, Horninger W, Bartsch G, et al. Real-time elastography for detecting prostate cancer: Preliminary experience. BJU Int. 2007;100:42–46. Scialpi M, D'Andrea A, Martorana E, Malaspina CM, Aisa MC, Napoletano M, et al. Biparametric MRI of the prostate. Turk J Urol. 2017 Dec;43(4):401-409. Mahajan M, Choudhary A, Dsouza J, Joshi P. Accuracy of transrectal strain elastography in detection of prostate cancer. West African Journal of Radiology. 2019;26(1):31-36. Kobilnyk Y, Mytsyk Y, Borzhiyevs’kyy A, Story O, Dutka I, Komnatska I, et al. Efficiency of the biparametric MRI in detection of prostate cancer: preliminary experience. European Journal of Medical Technologies. 2020;1(26):39-44. Kothapalli J, Peddi R. Elastography plus MRI image-based TRUS biopsy versus extended core biopsy for prostate cancer detection and diagnosis. European Journal of Molecular and Clinical Medicine. 2022;9(7): 2161-2165. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6090487","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":419690392,"identity":"03199d18-191b-4846-9625-6e69e60d492a","order_by":0,"name":"Dr Akshay Patil","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYFACxgbjPxX/5UDMAw+I08LcUMBzhtkYrCWBOC3sDR9425gTG0BsorTwz25s3CDZxpY+P+zwQ6AtdnK6DQS0SNw52GxgcI4nd+PtNAOglmRjswOErLmR2GaQUCaRu3F2AkjLgcRthLTI30hs/3GAzSDdcHb6B+K0GNxIbDBsaEtIkJfOIdIWwzsHG4wZzhww3CCdU3AgwYAIv8jdbn9gzFBxQF5+dvrmDx8q7OQIe18C5kKwSgNCypG1yDcQo3oUjIJRMApGJAAA91ZLnEJ87WgAAAAASUVORK5CYII=","orcid":"","institution":"Kasturba medical college, Manipal","correspondingAuthor":true,"prefix":"Dr","firstName":"Akshay","middleName":"","lastName":"Patil","suffix":""},{"id":419690485,"identity":"39664f0c-ade4-4fde-954d-1ef0ff09dd7a","order_by":1,"name":"Dr Anand Venugopal","email":"","orcid":"","institution":"Kasturba medical college, Manipal","correspondingAuthor":false,"prefix":"Dr","firstName":"Anand","middleName":"","lastName":"Venugopal","suffix":""}],"badges":[],"createdAt":"2025-02-23 13:55:12","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":true,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":true},"doi":"10.21203/rs.3.rs-6090487/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6090487/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":77336689,"identity":"7fce1237-edf8-4542-b669-3a4885e83b77","added_by":"auto","created_at":"2025-02-27 14:21:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":237306,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6090487/v1/6152d83d-8adf-4221-9013-1fa2b551d5c5.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eBiparametric MRI and Strain Elastography for Improving Cognitive Targeting in Prostate Cancer Detection\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eProstate cancer is one of the commonest types of cancer affecting men worldwide. It is the third leading cause of death, the first two being lung cancer and colorectal cancer. Prostate cancer does not lead to death by itself, instead death commonly is caused by the metastases to the brain, rectum, spinal cord, bladder or bones (1).\u003c/p\u003e \u003cp\u003eThe prostate is cone shaped and located within the sub-peritoneal region. It is situated between the rectum and pubic symphysis. The peripheral zone (PZ) is the largest of the four zones that make up the prostate. The remaining areas are the anterior fibromuscular stroma, transition zone (TZ), and central zone (CZ), which contains 25% of the glandular tissue (2). Prostate cancer instances can arise from PZ in up to 70% of cases, TZ in 20%, and CZ in just 1% of cases (3).\u003c/p\u003e \u003cp\u003eSince localized prostate cancer lesions rarely cause symptoms, it might be challenging to identify them until the disease has progressed to an advanced stage (4). Numerous symptoms, such as increased frequency of urination, incontinence, and nocturia, may be brought on by different prostate illnesses, such as benign prostatic hyperplasia (BPH). Therefore, screening becomes extremely important (4). Increased level of serum prostate-specific antigen (PSA) was the test used for screening for prostate cancer. Due to its lack of specificity, PSA levels might rise with increasing physical activity, comparable circumstances, and other prostatic diseases including prostatitis or BPH (4).\u003c/p\u003e \u003cp\u003eStrain Elastography is a technique that dynamically estimates the stiffness of the tissue by applying an external force and measuring the degree of distortion. As cancerous tissue has greater stiffness as compared to the normal tissue and the tissue of benign lesions, therefore, this technique has been used to differentiate malignant lesions in liver, breast, thyroid and cervix. Recent studies have demonstrated its utility in diagnosing prostate cancer (5).\u003c/p\u003e \u003cp\u003eIn biparametric MRI, mainly two types of sequences are used. These include: T2W and DWI with ADC. It does not use any type of contrast agent. Therefore, it has shorter acquisition time, is less expensive, has lower risk of allergic reactions and is safe for use in patients with medical conditions resulting in contradictions to the use of contrast (6).\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e This retrospective analysis was conducted from March 2022 to December 2024 in a tertiary care hospital in the coastal region of Karnataka, with ethical approval obtained from the Institutional Ethics Committee. In order to identify prostate cancer, the study sought to assess the diagnostic performance of transrectal ultrasonography (TRUS) with strain elastography and biparametric MRI.\u003c/p\u003e \u003cp\u003eThe study comprised the medical records of 32 male patients, ranging in age from 45 to 85, who had anomalies found during digital rectal examination (DRE) or had increased PSA values (\u0026gt;\u0026thinsp;4.0 ng/dL). The investigation did not include patients having a history of radiation therapy, hormone therapy, prostate procedures, or inflammatory bowel disease.\u003c/p\u003e \u003cp\u003eBiparametric MRI and TRUS with strain elastography results were among the patient data that were retrospectively examined from hospital records. A 1.5 T MRI scanner (Achieva Philips) was used for MRI scans, and a Samsung RS80 evo was used for TRUS and elastography. Prior to imaging, bowel preparation and antibiotic prophylaxis were administered to every patient. TRUS-guided biopsies were carried out utilizing 12-core samples in addition to extra targeted biopsies from worrisome lesions found by imaging.\u003c/p\u003e \u003cp\u003eBiparametric MRI sequences included diffusion-weighted imaging (DWI) and T2-weighted imaging (TWI) without the need for contrast materials. Tissue stiffness was evaluated using TRUS elastography, where soft (benign) and stiff (malignant) tissues were distinguished on color-coded maps. Under TRUS supervision, targeted biopsies were carried out using an 18G semiautomated biopsy needle, and biopsy samples were sent for histological analysis.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean age of the study population was 68.69\u0026thinsp;\u0026plusmn;\u0026thinsp;8.32 years, with the majority (40.62%) of cases falling in the 66\u0026ndash;75 age group. Malignancy was seen in 56.25% of cases (18/32), while 43.75% (14/32) were benign. There was no statistically significant difference in the mean age between benign and malignant cases (P\u0026thinsp;=\u0026thinsp;0.226). The age distribution showed that prostate cancer predominantly affected men above 65 years. The mean prostate volume for the cohort was 45.44\u0026thinsp;\u0026plusmn;\u0026thinsp;23.03 cc. Although patients with benign conditions had a higher average prostate volume (53.64\u0026thinsp;\u0026plusmn;\u0026thinsp;25.68 cc) compared to those with malignancy (39.06\u0026thinsp;\u0026plusmn;\u0026thinsp;19.09 cc), the difference was not statistically significant (P\u0026thinsp;=\u0026thinsp;0.075). The mean PSA level in the study population was 22.65\u0026thinsp;\u0026plusmn;\u0026thinsp;24.70 ng/mL, with no significant difference between benign and malignant cases (P\u0026thinsp;=\u0026thinsp;0.358).\u003c/p\u003e \u003cp\u003eBiparametric MRI categorized patients using the PI-RADS scoring system, with most patients falling into the PI-RADS 4 category (53.12%). There was no significant difference in PI-RADS scoring between benign and malignant lesions (P\u0026thinsp;=\u0026thinsp;0.441). However, further stratification revealed that PI-RADS 5 was associated with clinically significant prostate cancer, particularly in cases where the Gleason score was \u0026ge;\u0026thinsp;7. Meanwhile, PI-RADS 3 and 4 were more commonly seen in benign and clinically insignificant cancers.\u003c/p\u003e \u003cp\u003eStrain elastography showed that tissue stiffness (blue areas) was a strong indicator of malignancy. A total of 75% of cases had stiff areas, with 94.44% of these cases being malignant. Conversely, softer regions (red areas) were only present in benign cases (14.29%) and were absent in malignant ones. The difference in tissue stiffness between malignant and benign cases was statistically significant (P\u0026thinsp;=\u0026thinsp;0.015). This suggests that TRUS/strain elastography is highly effective in distinguishing malignant from benign lesions based on tissue hardness.\u003c/p\u003e \u003cp\u003eWhen evaluating the performance of TRUS/strain elastography and biparametric MRI for the detection of prostate cancer, TRUS/strain elastography showed a higher sensitivity (94.44%) compared to biparametric MRI (76.47%). However, biparametric MRI had slightly higher specificity (53.33%) compared to TRUS/strain elastography (50%). Combining both techniques resulted in a moderate diagnostic accuracy, with a sensitivity of 72.22% and specificity of 76.67%. This suggests that using both modalities together may enhance diagnostic accuracy, particularly for detecting clinically significant prostate cancer.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eProstate Ca is the third most prevalent cancer affecting males. The gold standard for diagnosis is systematic biopsy and histologic examination. But it is invasive, and the lesion may be missed on biopsy. Non-invasive techniques like DRE and ultrasound have lower sensitivity and specificity. Therefore, the present study was conducted to evaluate the efficacy of TRUS/Strain elastography and biparametric MRI in detection of prostate cancer.\u003c/p\u003e \u003cp\u003eStrain elastography demonstrated high sensitivity (94.44%) in detecting malignancy, with stiffer (blue) regions strongly associated with cancer. This finding aligns with the known increased stiffness of malignant tissue, making strain elastography a valuable non-invasive diagnostic tool. In study by Mahajan M. et al, they evaluated strain elastography for the diagnosis of prostate cancer. They observed that the sensitivity of strain elastography was 85.7%, specificity was 94.4%, PPV was 85.7% and NPV was 94.4% (7).\u003c/p\u003e \u003cp\u003eBiparametric MRI, while slightly less sensitive, provided detailed anatomical information. Most clinically significant cancers (Gleason score\u0026thinsp;\u0026ge;\u0026thinsp;7) were categorized as PI-RADS 5, confirming MRI\u0026rsquo;s utility in detecting more aggressive cancers. Although MRI had lower sensitivity than elastography, its specificity was marginally higher. In the study by Kobilnyk Y. et al, they observed that most of the cases with clinically significant cancer had PI-RADS 4 and 5 (69.2%) as compared to 33.3% cases with clinically insignificant cancer having PI-RADS 4 and there was no case having PI-RADS 5 (8).\u003c/p\u003e \u003cp\u003eWhen both modalities were combined, the diagnostic performance improved, yielding a sensitivity of 72.22% and a specificity of 76.67%. This demonstrates that a combined approach can enhance the detection of clinically significant prostate cancer, reducing missed diagnoses and unnecessary biopsies. In the study by Kothapalli J. and Peddi R., they evaluated the combined efficacy of mpMRI with elastography. They observed that the combined sensitivity for detection of prostate cancer was 84.5% and specificity was 82% (9).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe combination of TRUS/strain elastography and biparametric MRI enhances the accuracy of prostate cancer detection, offering a more comprehensive diagnostic tool that could improve patient outcomes while minimizing unnecessary interventions.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSchatten H. Brief Overview of Prostate Cancer Statistics, Grading, Diagnosis and Treatment Strategies. Adv Exp Med Biol. 2018; 1095:1-14.\u003c/li\u003e\n \u003cli\u003eYacoub JH, Oto A. MR Imaging of Prostate Zonal Anatomy. Radiol Clin North Am. 2018 Mar;56(2):197-209.\u003c/li\u003e\n \u003cli\u003eMcNeal JE, Redwine EA, Freiha FS, Stamey TA. Zonal distribution of prostatic adenocarcinoma. Correlation with histologic pattern and direction of spread. Am J Surg Pathol. 1988 Dec;12(12):897-906.\u003c/li\u003e\n \u003cli\u003eCarlsson SV, Vickers AJ. Screening for Prostate Cancer. Med Clin North Am. 2020 Nov;104(6):1051-1062.\u003c/li\u003e\n \u003cli\u003ePallwein L, Mitterberger M, Struve P, Pinggera G, Horninger W, Bartsch G, et al. Real-time elastography for detecting prostate cancer: Preliminary experience. BJU Int. 2007;100:42\u0026ndash;46.\u003c/li\u003e\n \u003cli\u003eScialpi M, D\u0026apos;Andrea A, Martorana E, Malaspina CM, Aisa MC, Napoletano M, et al. Biparametric MRI of the prostate. Turk J Urol. 2017 Dec;43(4):401-409.\u003c/li\u003e\n \u003cli\u003eMahajan M, Choudhary A, Dsouza J, Joshi P. Accuracy of transrectal strain elastography in detection of prostate cancer. West African Journal of Radiology. 2019;26(1):31-36.\u003c/li\u003e\n \u003cli\u003eKobilnyk Y, Mytsyk Y, Borzhiyevs\u0026rsquo;kyy A, Story O, Dutka I, Komnatska I, et al. Efficiency of the biparametric MRI in detection of prostate cancer: preliminary experience. European Journal of Medical Technologies. 2020;1(26):39-44.\u003c/li\u003e\n \u003cli\u003eKothapalli J, Peddi R. Elastography plus MRI image-based TRUS biopsy versus extended core biopsy for prostate cancer detection and diagnosis. European Journal of Molecular and Clinical Medicine. 2022;9(7): 2161-2165.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Kasturba Medical College","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Biparametric MRI, Prostate cancer, Strain elastography","lastPublishedDoi":"10.21203/rs.3.rs-6090487/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6090487/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: One of the most prevalent cancers in males is prostate cancer, which can be difficult to diagnose because of its ambiguous early signs. Aiming to improve detection accuracy, transrectal ultrasonography (TRUS) in conjunction with strain elastography and biparametric MRI (bpMRI) is an emerging diagnostic approach.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A tertiary centre in coastal region of Karnatakacarried out this retrospective analysis between March 2022 and December 2024. Thirty-two male patients, ages 45 to 85, whose digital rectal examination revealed palpable anomalies or elevated PSA levels were included in the study. For the assessment of prostate lesions, patients underwent both bpMRI and TRUS/strain elastography. Histopathology results were used as the reference standard to compare the diagnostic performance of these modalities. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were all included in the data analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Of the 32 cases, 56.25% were diagnosed as malignant and 43.75% as benign. The sensitivity and specificity for TRUS/strain elastography were 94.44% and 50%, respectively, compared to 76.47% and 53.33% for bpMRI. Combining both modalities improved specificity to 76.67%. Lesions classified as PI-RADS 4 on bpMRI were the most common in clinically insignificant cancer, while PI-RADS 5 lesions were predominant in clinically significant cases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e TRUS/strain elastography demonstrated superior sensitivity compared to bpMRI in detecting prostate cancer. However, bpMRI contributed to better specificity, especially when combined with TRUS/strain elastography. This combined approach provides a promising method for improving the cognitive targeting of prostate cancer lesions, especially in clinically significant cases.\u003c/p\u003e","manuscriptTitle":"Biparametric MRI and Strain Elastography for Improving Cognitive Targeting in Prostate Cancer Detection","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-27 14:13:13","doi":"10.21203/rs.3.rs-6090487/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7a5ebb5c-e802-445d-93e2-0b168579ef73","owner":[],"postedDate":"February 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":44743322,"name":"Urology \u0026 Nephrology"}],"tags":[],"updatedAt":"2025-02-27T14:13:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-27 14:13:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6090487","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6090487","identity":"rs-6090487","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}