To evaluate the value of real-time elastography (RTE)-guided targeted biopsy and inflow time mapping (ITM)-guided targeted biopsy for the detection of prostate cancer on the basis of systemic biopsy (SB).

A total of 103 patients suspected of having prostate cancer were selected from April 2017 to September 2018 at the First Affiliated Hospital of Harbin Medical University. All patients underwent RTE-guided targeted biopsy and ITM-guided targeted biopsy before 8-core SB. The detection rates for prostate cancer were compared between the combination method and SB alone. The ROC curves of peak strain index (PSI), peak time difference, and peak intensity difference in ITM for the diagnosis of prostate cancer were plotted between the suspicious malignant area and its contralateral areas to evaluate the diagnostic efficacy.

Among the 103 patients with suspected prostate cancer, 35, 34, and 30 patients were detected with prostate cancer by RTE-targeted biopsy, ITM, and SB, respectively. When combining the three biopsy methods together, 14 more patients were detected compared with SB alone. Adding RTE-targeted biopsy and ITM-targeted biopsy on the basis of SB can increase the detection rate of prostate cancer (42.7% vs 29.1%, χ²=4.133, P=0.043). According to the pathological results of RTE-targeted biopsy, there was a significant difference in PSI values between the benign and malignant lesions (t=3.234, P<0.05). Prostate cancer was detected with the highest sensitivity (82.9%) and specificity (64.7%) when using a PSI threshold value of≥10.35, and the area under the curve (AUC) value was 0.756. In ITM, the differences in peak time, peak intensity, peak time difference, and peak intensity difference were statistically significant between the benign and malignant lesions (t=-3.877, 3.597, 3.493, and 5.157, respectively; P<0.05). The AUC of the peak time difference for the diagnosis of prostate cancer was 0.789. When the peak time difference was 6.055 s, the sensitivity and specificity were the highest, which were 0.735 and 0.812, respectively. The AUC of the peak intensity difference for the diagnosis of prostate cancer was 0.819. When the peak intensity difference was 18.16 dB, the sensitivity and specificity were the highest, which were 0.647 and 0.928, respectively.

Adding RTE-targeted biopsy and ITM-targeted biopsy on the basis of SB can improve the detection rate of prostate cancer compared to conventional SB. RTE and ITM have appreciated value in the differentiation of benign and malignant lesions in the prostate.