We investigated the prostate elasticity displayed by elastography and its correlation with the content and distribution of collagen
type I (Col1) and type III (Col3). A total of 62 patients underwent transrectal real-time tissue elastography (TRTE) examinations.
Targeted biopsies were performed after 12-core systematic biopsy. The tissues corresponding to the elastograms were stained with
picric acid-sirius red. The distribution of Col1 and type Col3 was observed, and the collagen volume fraction (CVF) of these two types
of collagen fi bers was calculated. The CVFs of Col1 in the stiff and soft groups were 0.05 ± 0.02 and 0.02 ± 0.01 (P = 0.002),
respectively. The CVFs of Col3 in the stiff and soft groups were 0.05 ± 0.04 and 0.07 ± 0.03 (P = 0.13), respectively. The circular
analysis results showed that collagen fi bers were disorganized both in the soft and stiff groups. Col1 and Col3 were mainly cross-linked,
and some parallelization was observed in the sections. The distributions of Col1 and Col3 were different between the stiff and soft
groups (P = 0.03). In conclusion, the texture of the prostate is due to the content of Col1 and its relative correlation with Col3.

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