A new 5-grading score in the diagnosis of prostate cancer with real-time elastography.

Objective: To evaluate the clinical significance of transrectal real-time elastography (TRTE) in diagnosis of prostate cancer (PCA).

Methods: 195 patients with an elevated PSA level were enrolled in the study. A novel 5-grading score of prostate outer gland was applied by TRTE imaging. Receiver-operating characteristic curve (ROC) analyses were performed to assess the diagnostic performance of TRTE score.

Results: TRTE scores in patients with PCA and benign condition were 3.20 ± 1.11 (range: 1-5) and 2.24 ± 1.01 (range: 1-4), respectively (P < 0.001). The best cutoff value of TRTE score was 3, and the sensitivity, specificity, accuracy in the diagnosis were 68.6% (35/51), 69.4% (100/144) and 69.2% (135/195), respectively. The accuracy of TRTE in volume ≤ 30 ml group was significantly higher than that in the volume ≥ 50 ml group and the 30-50 ml group (76.9% vs. 65.0% and 76.9% vs. 71.4%, both P < 0.001). Accuracy of TRTE score was higher for those with PSA ranged 4-10 ng/ml than those with PSA > 10 ng/ml (85.3% vs. 66.7%, P = 0.002).

Conclusion: TRTE score, a novel semi-quantitative assessment of patients' prostate stiffness, can be served as a useful screening method for patients suspicious of PCA, especially those only having an elevated PSA level.