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Johns Hopkins Pediatric

Transrectal Ultrasound Is Getting an Upgrade

 “Compared with LoTRUS, HiTRUS was both more sensitive and specific. It also was better at showing high-grade lesions.”
Christian Pavlovich, MD

Winter 2015

It’s new, it’s first-generation and nobody’s suggesting that it is ready to replace prostate biopsies, but high-resolution ultrasound (HiTRUS) has shown great potential in its first-ever pilot study. Now it’s being investigated in a multi-institutional, randomized trial of prostate biopsy involving five centers in the U.S. and Canada.

“Prostate imaging by HiTRUS (16-21 MHz) had never been done before,” says Christian Pavlovich, director of urologic oncology at Johns Hopkins Bayview Medical Center and the pilot study’s principal investigator who’s spearheading the new trial. “What we were trying to do initially was see how well it performed against conventional transrectal ultrasound (LoTRUS at 7-12 MHz) in identifying clinically localized prostate cancer.” 

In the first trial, a blinded study, 25 men who were scheduled for radical prostatectomy were imaged before surgery with both LoTRUS and HiTRUS; those images were correlated with the areas where the cancers were found by pathologists after surgery, and the accuracy of each imaging modality was compared. In that study, reported inUrologic Oncology, HiTRUS clearly outperformed LoTRUS: “Out of 69 sextant areas with prostate cancer, HiTRUS found 45 and missed 24, while LoTRUS visualized 26 and missed 43,” says Pavlovich. “Compared with LoTRUS, HiTRUS was both more sensitive and specific. It also was better at showing high-grade lesions.”

Pavlovich believes a few upgrades to the technology, such as image-enhancing Doppler flow and more experience with HiTRUS images of the prostate, will make the technology and outcomes even better. “The potential is exciting,” he says. He also likes the fact that this is not a completely new and complicated imaging system; it’s just a better version of a tool that’s “already a standard part of the clinical practice of every urologist who performs prostate biopsy in the U.S.” Indeed, “there is a great need for urologist-performed, office-based prostate imaging to better identify men with an elevated PSA or abnormal DRE who should undergo a prostate biopsy, and to perhaps target this biopsy more accurately in real time.” 

Ultimately, he adds, the combination of HiTRUS and MRI may prove good enough to reduce the number of biopsies that need to be performed.

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See How Johns Hopkins Urologists Perform Nerve-Sparing Robotic Radical Prostatectomy go to to watch the steps involved in an actual operation to remove a prostate while preserving the antegrade neurovascular bundle.

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