The role of diagnostic ultrasound imaging for patients with known prostate cancer within an active surveillance pathway: A systematic review

Abstract

Background The use of multiparametric magnetic resonance imaging (mpMRI) within active surveillance of prostate cancer programmes is identified by the UK National Institute for Health and Care Excellence (NICE guideline NG 131 2019) as having a role for monitoring disease. The widespread demands on mpMRI capacity may limit its use in surveillance. It is therefore timely to review the options that modern ultrasound imaging present to this cohort of patients in the monitoring of prostate cancer. Methods Between April and September 2020, 10 databases were searched to recruit studies for the review. Three reviewers evaluated the publications for inclusion. Characteristics including the inclusion criteria for the study cohort, how disease was determined, identification of disease progression, and the modality and mode of imaging used were reviewed. Given the paucity of full text articles, a meta-analysis was not possible. A narrative review was undertaken. Results In total, 12 studies, utilising the range of ultrasound parameters of B-mode, micro-ultrasound, colour Doppler, contrast ultrasound and elastography were included. The review demonstrated that micro-ultrasound offers promise as an imaging tool comparable with mpMRI. However, this is an emerging technology with limited availability. Analysis of the data further demonstrated that by combining the diagnostic features provided by multiple modes reviewed, ultrasound has a role in the diagnostic imaging of patients on active surveillance. Conclusion Providing a multiparametric approach is utilised, stable ultrasound findings may allow for increased intervals between biopsy for men on surveillance. The advent of micro-US offers promise as an imaging modality within an active surveillance pathway but requires further verification.

Embedding new technology into clinical ultrasound practice: Is role extension for sonographers the key to improving patient pathways?

“…2 Early evidence suggests that microUS will play an important role in assessing prostate disease, particularly in those patients in whom MRI is contraindicated. 3 Here in the UK, only two sites currently have microUS systems and we believe ours is the only one being used solely by sonographers.…”

“…The sparsity of published evidence regarding the use of microUS indicates that this is a novel regime and practitioners undertaking, interpreting and evaluating the outcomes of such imaging will require significant knowledge and skill development if it is to be a useful reliable tool. 3 As with implementation of any new technology, challenges frequently have to be overcome prior to embedding into routine clinical practice and, in this case, it is the radiology team that has the opportunity to reassess the traditional diagnostic pathway by developing the sonographer workforce to be able to use microUS.…”

Active Surveillance in Prostate Cancer: Current and Potentially Emerging Biomarkers for Patient Selection Criteria

“…Specificities of micro-u/s and MRI were both 22%, with similar PPV (44 vs. 43%). In a systematic review recently published by Parker et al [69], the authors reviewed the utility of different modern ultrasounds in AS for PCa. Twelve studies, utilizing the range of ultrasound parameters of B-mode, micro-u/s, color Doppler, contrast ultrasound, and elastography, were included.…”