Abstract
Objectives: To determine the prognostic significance of tissue stiffness measurement using transrectal ultrasound shear wave elastography in predicting biochemical recurrence following radical prostatectomy for clinically localized prostate cancer.Patients and Methods: Eligible male patients with clinically localized prostate cancer and extraperitoneal laparoscopic radical prostatectomy between November 2013 and August 2017 were retrospectively selected. Information of potential biochemical recurrence predictors, including imaging (ultrasound shear wave elastography and magnetic resonance imaging), clinicopathological characteristics, and preoperative prostate specific antigen (PSA) levels were obtained. Recurrence-free survival (Kaplan–Meier curve) and a multivariate model were constructed using Cox regression analysis to evaluate the impact of shear wave elastography as a prognostic marker for biochemical recurrence.Results: Patients experienced biochemical recurrence in an average of 26.3 ± 16.3 months during their follow-up. A cutoff of 144.85 kPa for tissue stiffness measurement was estimated for recurrence status at follow-up with a sensitivity of 74.4% and a specificity of 61.7%, respectively (p < 0.05). In univariate analysis, shear wave elastography performed well in all preoperative factors compared to biopsy Gleason Score, PSA and magnetic resonance imaging; in multivariate analysis with postoperative pathological factors, shear wave elastography was statistically significant in predicting postoperative biochemical recurrence, which improved the C-index of predictive nomogram significantly (0.74 vs. 0.70, p < 0.05).Conclusions: The study revealed that quantitative ultrasound shear wave elastography-measured tissue stiffness was a significant imaging marker that enhanced the predictive ability with other clinical and histopathological factors in prognosticating postoperative biochemical recurrence following radical prostatectomy for clinically localized prostate cancer.
Highlights
The primary goal of biomarker/predictive test research in the field of prostate cancer (PCa) is to increase the prediction rate of postoperative outcome and/or biochemical recurrence (BCR)
There are several known predictors for BCR following surgical therapy for PCa published in the literature, e.g., age, prostate specific antigen (PSA), biopsy Gleason Score, clinical stage, pathology Gleason Score, and other postoperative data [3]; ultrasound imaging, ultrasound
We have recently shown that the technology can reliably predict the grade of cancer and may provide essential information on the biology and microenvironment of the cancerous lesions
Summary
The primary goal of biomarker/predictive test research in the field of prostate cancer (PCa) is to increase the prediction rate of postoperative outcome and/or biochemical recurrence (BCR). Radical prostatectomy (open or minimally invasive) is an established treatment option for clinically localized PCa. Thirty to forty percent of men show postoperative BCR and require further adjuvant or salvage treatments on follow-up [1, 2]. Predicting recurrence would be useful in setting up personalized treatment plans for patients, as well as selecting men for adjuvant treatment following prostatectomy. There are several known predictors for BCR following surgical therapy for PCa published in the literature, e.g., age, prostate specific antigen (PSA), biopsy Gleason Score (bGS), clinical stage, pathology Gleason Score (pGS), and other postoperative data [3]; ultrasound imaging, ultrasound
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