Biparametric MRI and strain elastography for improving cognitive targeting in prostate cancer detection

Abstract Background Prostate cancer is one of the most frequently diagnosed malignancies among men worldwide and remains a major contributor to cancer-related mortality. Conventional diagnostic tools such as prostate-specific antigen (PSA) testing and transrectal ultrasound (TRUS)-guided biopsy have notable limitations in sensitivity and specificity. Recent advancements in imaging, including biparametric magnetic resonance imaging (bpMRI) and strain elastography, have demonstrated improved diagnostic performance in identifying clinically significant prostate cancer. Objective To evaluate the diagnostic accuracy of combining TRUS with strain elastography and biparametric MRI in enhancing cognitive targeting for prostate cancer detection. Methods This retrospective study included 32 patients presenting with elevated PSA levels or abnormal digital rectal examination findings. All patients underwent bpMRI followed by TRUS with strain elastography prior to biopsy. Imaging findings were correlated with histopathological outcomes. Statistical analysis included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), with significance assessed using chi-square and t-tests. Results Malignancy was detected in 56.25% of patients. Strain elastography demonstrated a statistically significant association with malignancy ( p = 0.015), with stiff (blue) areas correlating strongly with cancerous lesions. bpMRI showed high diagnostic performance, particularly in PI-RADS 4 and 5 lesions. The combined approach improved specificity and lesion localization, although this was associated with a reduction in sensitivity due to the use of a concordance-based diagnostic strategy. Conclusion The combined use of biparametric MRI and TRUS strain elastography improves specificity and lesion localisation in prostate cancer detection and may support cognitive targeting in settings where fusion-guided biopsy is not available. However, this approach is associated with a trade-off in sensitivity, and findings should be interpreted cautiously given the small sample size. Further prospective studies with larger cohorts are required to validate these results.