Abstract
BACKGROUND: Prostate cancer (PCa) is the second most diagnosed type of cancer in men worldwide. Conventional ultrasound-guided systematic prostate biopsies demonstrate limited accuracy and a high false-negative rate, which may increase procedural risks and potential complications. The aim of this study was to evaluate the diagnostic performance of transrectal ultrasound (TRUS) combined with shear wave elastography (SWE) and clinical indicators for the detection of PCa. METHODS: A total of 375 patients with elevated prostate-specific antigen (PSA) levels were enrolled. Patients' age, prostate stiffness values, PSA density (PSAD), PSA levels, and prostate volume (PV) were analyzed. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis to determine optimal cut-off values and simple models. Additionally, the diagnostic performance of different parameters for PCa was evaluated at varying PSA levels. RESULTS: In all patients, PSAD demonstrated superior diagnostic performance compared to age, PSA, PV, and SWE alone. Optimal threshold values for PSAD and SWE were 0.62 ng/mL(2) and 61.07 kPa, respectively. The combination of SWE + PSAD exhibited the highest diagnostic performance [area under the curve (AUC) =0.91, P<0.05]. In patients with PSA levels >20 ng/mL, optimal threshold values for PSAD and SWE were 0.97 ng/mL(2) and 57.97 kPa, respectively. The combination of SWE + PSAD exhibited the highest diagnostic performance (AUC =0.96, P<0.05). CONCLUSIONS: The cutoff value of SWE is dependent on their serum PSA level, and SWE yields higher diagnostic efficacy at PSA levels exceeding 20 ng/mL. The combination of SWE + PSAD shows better diagnostic efficacy for PCa than other parameters, while integrating imaging with clinical data can further enhance the diagnostic yield.