Transurethral Shear Wave Elastography (TU-SWE) for Prostate Cancer Diagnosis

Prostate Cancer (PCa) is the most common cancer in men in the UK. It is also the second cause of cancer death after lung cancer. It represents around 13% of all cases of cancer and accounts for 7% of all UK cancer deaths. The incidence of PCa increases with age, affecting mainly men over 50 years of age. Prostate carcinoma is often suspected when the serum Prostate-Specific Antigen (PSA) is elevated or an abnormal digital rectal examination is noted. However, PSA screening leads to a substantial number of unnecessary biopsies in patients with no or indolent cancer, who do not need immediate treatment. Despite the low specificity of PSA testing and the uncertainty after negative systematic biopsies, these techniques remain the standard for PCa diagnosis.

Current research is investigating whether modern imaging techniques can identify the site of the tumour. There are two main streams that are showing promising preliminary results: Magnetic Resonance Imaging (MRI) and Elastography techniques. MRI is showing promising results, particularly when using a multi-parametric approach (mpMRI), but its high cost and limited availability hold back its wider use, particularly in resource-poor parts of the world. Prostate Elastography is an emerging imaging modality, which consists of the evaluation of prostate stiffness. Analogous to the cellular processes of wound repair, it is generally believed that normal tissue stroma responds in an effort to repair damage due to carcinoma cell invasion. It has been concluded that the stromal reaction is also characterized by elevated collagen deposition. Since increasing collagen deposition leads to an increase in the tumour rigidity, this suggests that quantitative stiffness estimations may prove to be an effective biomarker for assessing PCa grade and identification of more aggressive cancers.

With regards to treatment options, radical surgery and whole-gland therapies remain controversial for treatment of localised prostate cancer...