Prospective blinded comparison of real-time sonoelastography targeted versus randomised biopsy of the prostate in the primary and re-biopsy setting.

PURPOSE: To investigate cancer detection rates and percentage of tumour per core between real-time sonoelastography (RTE) targeted biopsy and lateralised tenfold random biopsy of the prostate in the primary and re-biopsy setting. METHODS: Patients undergoing primary or re-biopsy of the prostate were included. Systematic RTE (EUB 7500, Hitachi Medical Systems, Tokio, Japan) was performed with the patient in the left lateral position. A maximum of four RTE targeted biopsies of the peripheral zone were taken following by a lateralised tenfold biopsy done by a second investigator blinded to the RTE findings. RTE targeted and random biopsy cylinders from corresponding areas were compared for percentage of tumour per core. Chi-square test and Wilcoxon signed rank test were used to compare differences between different groups. RESULTS: One hundred and thirty-nine patients were included (52 with primary biopsy, 87 with re-biopsy). Prostate cancer was found in 73 (52.5%) patients. Cancer detection rates per core were 23.2% versus 9.2% and 21.9% versus 12.7% for RTE targeted and random biopsies in the primary and re-biopsy setting, which was statistically significant (P < 0.05). The mean percentage of prostate cancer per core from corresponding areas was significantly higher in RTE targeted compared to random biopsy cores with 21.5% versus 16.4% (P < 0.05). CONCLUSIONS: RTE targeted biopsy significantly increases cancer detection rates per core in comparison with random biopsy. The difference is more pronounced in the primary biopsy setting. RTE targeted biopsy cores are of improved diagnostic value due significantly higher percentages of cancer compared to random biopsy cores.