Diagnostic ultrasound is a viable means to assess bladder1 breast2, skin/melanoma3, liver, endometrial4, and thyroid malignancies and can be performed in the office setting accurately and rapidly due to the high resolution and low cost of today’s sonographic equipment. This diagnostic technology requires extensive experience and training in interpreting the images. However, advances in the computerization of the imaging, blood flow, and tumor measures of exact volume and vessel density are now less operator-dependent. That provides for an accurate and repeatable diagnosis, and a means to follow the individual patient’s unique pattern of cancer development, progress, and response to treatment. Recent technological advances also make these procedures available to much broader clinical application, without requiring years of unique training and experience, for example, with diagnoses of cystic versus lesions. These advances are applicable beyond prostate cancer, the example used here, because it has been shown to be reproducible over the last 20 years with pathologic confirmation of the findings of the various imaging modalities. For the clinician new to the use of these technologies, it must be emphasized that initial readings will be difficult to interpret and may contain many confusing artifacts. It is recommended that findings should be confirmed with all pertinent imaging modalities.
One man in 6 will be diagnosed with this disease in his lifetime. It is, at the same time, the second biggest cancer killer in men, with an estimated 29,720 deaths in 2015 in the United States. Like other cancers in the past, our understanding of the science of prostate cancer has changed tremendously during the last 10 years. Pre-malignant conditions have been described leading to an extremely active search for genomic signatures of prostate cell transformation. Cohort studies are ongoing. The diagnosis of prostate cancer has become more sophisticated with the introduction of newer criteria, outside of the classical Gleason classification, that could predict an individual’s tumor aggressiveness, with the hope of better and more personalized tailored therapeutic strategies.5 3D imaging may not detect regional and distant lymph nodes, so MRI remains the gold standard for nodal staging.
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