Biparametric MRI and Strain Elastography for Improving Cognitive Targeting in Prostate Cancer Detection

Background : One of the most prevalent cancers in males is prostate cancer, which can be difficult to diagnose because of its ambiguous early signs. Aiming to improve detection accuracy, transrectal ultrasonography (TRUS) in conjunction with strain elastography and biparametric MRI (bpMRI) is an emerging diagnostic approach. Methods : A tertiary centre in coastal region of Karnatakacarried out this retrospective analysis between March 2022 and December 2024. Thirty-two male patients, ages 45 to 85, whose digital rectal examination revealed palpable anomalies or elevated PSA levels were included in the study. For the assessment of prostate lesions, patients underwent both bpMRI and TRUS/strain elastography. Histopathology results were used as the reference standard to compare the diagnostic performance of these modalities. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were all included in the data analysis. Results : Of the 32 cases, 56.25% were diagnosed as malignant and 43.75% as benign. The sensitivity and specificity for TRUS/strain elastography were 94.44% and 50%, respectively, compared to 76.47% and 53.33% for bpMRI. Combining both modalities improved specificity to 76.67%. Lesions classified as PI-RADS 4 on bpMRI were the most common in clinically insignificant cancer, while PI-RADS 5 lesions were predominant in clinically significant cases. Conclusion: TRUS/strain elastography demonstrated superior sensitivity compared to bpMRI in detecting prostate cancer. However, bpMRI contributed to better specificity, especially when combined with TRUS/strain elastography. This combined approach provides a promising method for improving the cognitive targeting of prostate cancer lesions, especially in clinically significant cases.