Sweep and Scrutinize: Improving Prostate Cancer Diagnostic Efficacy by Combining Whole‐Gland Contrast‐Enhanced Transrectal Ultrasound With Fixed‐Plane Flash‐Replenishment Imaging

Objectives To evaluate whether the addition of whole‐gland contrast‐enhanced transrectal ultrasound (CETRUS) and fixed‐plane flash‐replenishment imaging (FRI) to conventional transrectal ultrasound (TRUS) improves the diagnostic efficacy of prostate cancer (PCa) in patients with prostate‐specific antigen (PSA) levels of 4.00–20.00 ng/mL. Methods A total of 163 patients scheduled for TRUS‐guided biopsy due to elevated PSA (4.00–20.00 ng/mL) were enrolled. Each patient underwent conventional TRUS, whole‐gland CETRUS, and FRI before biopsy. Detection rates and diagnostic efficacy for PCa were compared among 3 imaging strategies: conventional TRUS alone, the combination of conventional TRUS with whole‐gland CETRUS, and the triple combination. Results PCa was diagnosed in 62 of 163 (38.04%), including 29 (46.77%) clinically significant cases. The detection rates were 43.56% for conventional TRUS, 57.06% for conventional TRUS combined with whole‐gland CETRUS, and 61.35% for the triple combination. Only 5 clinically insignificant cases were missed by the combined approach. The triple combination demonstrated the highest area under the ROC curve (AUC = 0.747), significantly outperforming conventional TRUS (AUC = 0.669, p = .018) and TRUS with whole‐gland CETRUS (AUC = 0.703, p = .026). The combined method also identified significantly more positive biopsy cores (p ‐ Bonf < .001) by integrating the complementary diagnostic strengths of whole‐gland CETRUS (high positive predictive value (PPV) for rapid/hyperenhancement and diffuse abnormalities) and FRI (high PPV for asymmetric/focal enhancement). Conclusion The triple‐modality combination significantly improves PCa detection rate and diagnostic efficacy in patients with PSA levels of 4.00–20.00 ng/mL, offering a valuable alternative when magnetic resonance imaging is contraindicated or unavailable.