Imaging modalities in focal therapy: multiparametric ultrasound

OBJECTIVES: Prostate cancer (PCa) is the most common form of cancer among men in the US and the second most common cause of death. It has been observed that an increasing number of newly diagnosed patients exhibit low-risk features and that over-treatment with radical prostatectomy is a growing problem. The feasibility of focal therapy as an organsparing alternative, however, depends on the reliability of imaging techniques to identify, localize and monitor clinically relevant PCa lesions. The aim of this review is to investigate the potential of multiparametric ultrasound (mpUS) for focal therapy.METHODS: We briefly introduce the most common focal therapies and thoroughly discuss the ability of available ultrasound modalities to localize PCa and reflect tissue properties. The imaging requirements of the focal therapies are studied to put the performance of the US techniques into perspective.RESULTS: We found that transrectal greyscale echography, Doppler sonography, elastography, contrast-enhanced ultrasonography and computerized ultrasound have been studied for the purpose of prostate imaging. Several of these modalities are already frequently used in current clinical practice; to add to the diagnostic process of PCa, to guide and monitor the application of focal therapy or to perform follow-up after treatment. Despite their capability to detect a large fraction of the PCa lesions, none of these modalities is currently considered sufficiently accurate for stand-alone tumour detection and localization. However, although there are only few studies reporting on a combined use of different ultrasound modalities, the results of an mpUS approach seem promising.CONCLUSION: Several US modalities have been successfully applied as a viable alternative to monitor tissue destruction during and after treatment. In view of the advantages of US and the promising results of a multiparametric approach in PCa detection and localization, researchers are urged to further investigate mpUS for therapeutic purposes