From the Guidelines
Prostate cancer can appear as a heterogeneous echotexture on ultrasound, but this finding is not specific to cancer and can also be seen in other conditions like prostatitis or benign prostatic hyperplasia. The appearance of prostate cancer on ultrasound is often characterized by a hypoechoic area with heterogeneous echotexture, but approximately 30-40% of prostate cancers are isoechoic and difficult to distinguish from normal tissue 1. The heterogeneous appearance occurs because cancerous tissue disrupts the normal glandular architecture of the prostate, creating irregular patterns of sound wave reflection. This variability in tissue density and composition results in the heterogeneous appearance on ultrasound. Some key points to consider when evaluating prostate cancer with ultrasound include:
- Approximately 60-70% of prostate cancers appear hypoechoic on transrectal ultrasound (TRUS)
- Ultrasound alone is not sufficient for diagnosing prostate cancer, and suspicious findings typically require confirmation through targeted biopsies
- Modern prostate cancer detection often combines ultrasound with other imaging modalities like multiparametric MRI for improved diagnostic accuracy 1. It's also important to note that the use of multiparametric MRI is increasingly important for biopsy optimization, with a Cochrane meta-analysis showing that MRI had pooled sensitivity and specificity of 0.91 (95% CI: 0.83-0.95) and 0.37 (95% CI: 0.29-0.46) for ISUP grade 2 cancers, and 0.95 (95% CI: 0.87-0.99) and 0.35 (95% CI: 0.26-0.46) for ISUP grade 3 cancers, respectively 1.
From the Research
Prostate Cancer Appearance on Ultrasound
- Prostate cancer can appear as heterogeneous echotexture on ultrasound, characterized by focal areas of increased or decreased echogenicity with irregular margins 2.
- The appearance of prostate cancer on ultrasound can be explained by correlation with histological findings, which may show variations in tissue texture and abnormalities 2.
- Advanced ultrasound modalities, such as multiparametric ultrasound (mp-US), can improve the diagnosis of prostate cancer, but may not be sufficient to replace multiparametric MRI (mp-MRI) 3.
Comparison with Benign Conditions
- Benign prostatic hypertrophy and prostatitis can exhibit a homogeneous echo pattern on ultrasound, which can be distinguished from the heterogeneous appearance of prostate cancer 2.
- The use of mp-US and mp-MRI can provide complementary information to help differentiate between prostate cancer and benign conditions 3.
Heterogeneity of Prostate Cancer
- Prostate cancer is known for its clinical, spatial, and morphological heterogeneity, which can make diagnosis and treatment challenging 4.
- The heterogeneity of prostate cancer can be observed at different levels, including spatial heterogeneity within the prostate, morphological heterogeneity, and molecular genetic heterogeneity 4.