Can ultrasounds be useful during active surveillance for prostate cancer?

The aim of this study was to see if ultrasounds could be used as a tool to monitor low-risk prostate cancer patients in active surveillance. It was concluded that ultrasounds can be used to monitor changes in prostate cancer, and could extend the time between biopsies.

Low-risk prostate cancer is cancer that has not spread beyond the prostate. It is unlikely to grow or spread for many years.

Active surveillance can be used to monitor low-risk prostate cancer. With active surveillance, no treatment is given to the patients initially. The patient is given treatment if the cancer starts to grow. Blood tests to measure PSA levels (prostate specific antigen, a protein found in the blood associated with prostate cancer), digital rectal examination (checking prostate shape and size) and prostate biopsy are used during active surveillance.  A biopsy involves removing cells from the prostate. It is an invasive process.

Transrectal ultrasounds (TRUS) can create an image of the prostate gland and the area around it. It is unknown whether this tool can be used to monitor low-risk prostate cancer. 

The records of 875 men with low-risk prostate cancer were examined. They were under active surveillance. TRUS (at least two) was used to look for changes that meant the cancer was growing or spreading. Patients were monitored for an average of 49 months.

Based on TRUS, 39% of men were found to have cancer that progressed. 14% of these had an increase in size of the prostate. 74% had more lesions and 79% had moved to a later stage of cancer.

Of the men who showed progression on TRUS, 47% had an upgrade of disease stage based on biopsy and 53% who did not. In men who did not show progression on TRUS, 34% had a biopsy upgrade, while 66% did not.

The study concluded that progression on TRUS was associated with disease upgrades based on biopsy. The authors suggested that use of TRUS may limit repeat testing by biopsy. 

More studies are needed to see how useful this tool would be.  

Ask your physician about using TRUS during active surveillance.