Abstract

The standard diagnostic procedure for prostate cancer (PCa) is transrectal ultrasound (TRUS)-guided needle biopsy. However, due to the low sensitivity of TRUS to cancerous tissue in the prostate, small yet clinically significant tumors can be missed. Magnetic resonance imaging (MRI) with TRUS fusion biopsy has recently been introduced as a way to improve the identification of clinically significant PCa in men. However, the spatial errors in coregistering the preprocedural MRI with the real-time TRUS causes false negatives. A real-time and intraprocedural imaging modality that can sensitively detect PCa tumors and, more importantly, differentiate aggressive from nonaggressive tumors could largely improve the guidance of biopsy sampling to improve diagnostic accuracy and patient risk stratification. In this work, we seek to fill this long-standing gap in clinical diagnosis of PCa via the development of a dual-modality imaging device that integrates the emerging photoacoustic imaging (PAI) technique with the established TRUS for improved guidance of PCa needle biopsy. Unlike previously published studies on the integration of TRUS with PAI capabilities, this work introduces a novel approach for integrating a focused light delivery mechanism with a clinical-grade commercial TRUS probe, while assuring much-needed ease of operation in the transrectal space. We further present the clinical potential of our device by (i) performing rigorous characterization studies, (ii) examining the acoustic and optical safety parameters for human prostate imaging, and (iii) demonstrating the structural and functional imaging capabilities using deep-tissue-mimicking phantoms. Our TRUSPA experimental studies demonstrated a field-of-view in the range of 130 to 150 degrees and spatial resolutions in the range of 300 μm to 400 μm at a soft tissue imaging depth of 5 cm.

Highlights

  • Prostate cancer (PCa) has become the most commonly diagnosed nonskin cancer in American men, with an annual incidence rate of over 170,000 cases [1]

  • A transrectal ultrasound and photoacoustic imaging probe was developed by integrating focused light delivery with a commercial TRUS prostate probe

  • Characterization of the transrectal ultrasound and photoacoustic (TRUSPA) probe’s optical energy density, mechanical and thermal indices, as well as ISPTA and ISPPA acoustic intensities indicated that the probe is safe for human imaging for source voltages up to 50 V

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Summary

Introduction

Prostate cancer (PCa) has become the most commonly diagnosed nonskin cancer in American men, with an annual incidence rate of over 170,000 cases [1]. Differentiating aggressive from indolent PCa is critical for improving patient outcomes and preventing metastasis and death. Transrectal ultrasound (TRUS)-guided biopsy is the standard procedure for evaluating the presence and aggressiveness of PCa. Since ultrasound (US) has limited sensitivity to cancerous tissue in the prostate, TRUS-guided biopsies yield 20–30% false negative rates [4,5,6]. A preprocedure magnetic resonance imaging (MRI) and TRUS fusion biopsy has been introduced recently to improve the identification of clinically significant PCa in men with prior negative biopsies [7,8,9,10,11]. The spatial errors in coregistering the preprocedural MRI with the real-time TRUS still yields a 10–20%

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