Use of ultrasound elastography for the diagnosis of prostate cancer: A systematic review

Ultrasound elastography (USE) has emerged as a promising non-invasive tool for prostate cancer (PCa) detection. This systematic review evaluates the diagnostic accuracy of USE techniques, including shear-wave elastography (SWE) and strain elastography (SE), in detecting PCa.

Following PRISMA guidelines, we conducted a comprehensive literature search across PubMed, Google Scholar, Science Direct, and Web of Science (2015-2025). Studies assessing USE diagnostic performance with histopathological confirmation (biopsy/prostatectomy) were included. Data on sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were extracted. Quality assessment was performed using QUADAS-2.

Among 18 studies, SWE demonstrated sensitivities of 58%-96.8% and specificities of 67.8%-98%, while SE showed 74.2%-100% sensitivity and 73.7%-93.8% specificity. Optimal stiffness cutoffs varied (41.0-82.6 kPa for SWE; strain ratio 1.9-5.5 for SE). Multiparametric approaches combining USE with MRI or targeted biopsy improved diagnostic accuracy (e.g., sensitivity 90.1%, specificity 80.6% for transrectal real-time elastography). USE correlated with Gleason scores, aiding in risk stratification.

USE exhibits strong diagnostic performance for PCa, particularly when integrated with multiparametric imaging. Standardization of protocols and further validation in large cohorts are needed to optimize clinical adoption.