Contrast-enhanced Gray-scale Transrectal Ultrasound-guided Prostate Biopsy in Men with Elevated Serum Prostate-specific Antigen Levels

Rationale and Objectives

Our goal was to evaluate the role of contrast-enhanced gray-scale transrectal ultrasound (CETRUS)-guided prostate biopsy in patients with elevated serum prostate-specific antigen (PSA) levels.

Materials and Methods

A total of 115 men (mean age, 70 years; range, 47−85) with serum PSA levels of greater than 4.0 ng/ml were assessed using gray-scale transrectal ultrasound (TRUS), power Doppler ultrasound (PDU), and CETRUS. Subsequently, these patients underwent systematic sextant transrectal biopsy and additional biopsies for positive sites on gray-scale TRUS, PDU, and CETRUS. The cancer detection rates of the three techniques were compared.

Results

Cancer was detected in 63 of the 115 patients (55%). CETRUS was positive in 50 patients, 35 of whom (70%) had prostate cancer; CETRUS had a higher sensitivity, specificity, and accuracy of 65% (41/63), 83% (43/52), and 73% (84/115), respectively. CETRUS could have saved a significant number of patients from undergoing unnecessary biopsies, compared to TRUS and PDU. However, no significant correlation was found between the Gleason score and CETRUS grade.

Conclusions

The use of CETRUS in detecting prostate cancer might reduce the number of unnecessary needle biopsies of the prostate in patients with abnormally high serum PSA levels and increase the detection rate of clinically significant prostate cancer.

Prostate cancer is one of the most notable causes of death from cancer in men. The detection of prostate cancer is generally based on digital rectal examination (DRE) and transrectal ultrasound (TRUS) findings and serum prostate-specific antigen (PSA) determination ( ). TRUS is the most commonly used imaging technique to guide the needle biopsy due to its excellent demonstration of zonal anatomy. However, multiple systematic random biopsies have been shown to overlook a large number of clinically significant carcinomas. This fact has led to a dramatic increase in the number of biopsy samples taken for the detection of localized prostate cancer ( ). There is an increasing need for improved diagnostic imaging to more accurately identify prostate cancer.

Prostate cancer tissue is associated with increased microvessel density due to the proliferation of neovessels. Microvessels in malignant tissue are smaller than those of benign prostate tissue ( ). The microvessels that proliferate in prostate cancer are below the resolution of conventional Doppler imaging; only the larger feeding vessels are visualized by this type of imaging ( ).

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Materials and methods

Patients

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Contrast-Enhanced Transrectal Gray-scale Ultrasonography and Image Analysis

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Transrectal Ultrasound-guided Biopsy

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Statistical Analysis

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Results

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Table 1

Relationship Between the Contrast-Enhanced Gray-Scale Transrectal Ultrasound (CETRUS) Grades and the Biopsy Results ( n = 115)

Histologic Finding CETRUS Grade Total (%) 0 1 2 3 Cancer positive Gleason score 8−10 3 7 12 3 25 5−7 4 7 22 4 37 2−4 1 0 0 0 1 Subtotal 8 14 34 7 63 (55) Cancer negative BPH 32 7 4 0 43 Inflammatory change 2 1 3 1 7 PIN 0 1 1 0 2 Subtotal 34 9 8 1 52 (45) Total (%) 42 23 42 8 115 (100)

BPH: benign prostatic hyperplasia; PIN: prostatic intraepithelial neoplasia.

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Table 2

Relationship Between the Power Doppler Ultrasound (PDU) Grades and the Biopsy Results ( n = 115)

Histologic Finding PDU Grade Total (%) 0 1 2 Cancer positive Gleason score 8−10 10 8 3 21 5−7 16 21 4 41 2−4 1 0 0 1 Subtotal 27 29 7 63 (55) Cancer negative BPH 32 7 1 40 Inflammatory change 2 3 5 8 PIN 0 2 0 2 Subtotal 34 12 6 52 (45) Total (%) 61 41 13 115 (100)

BPH: benign prostatic hyperplasia; PIN: prostatic intraepithelial neoplasia.

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Table 3

Comparison of Test Performance for Prostate Cancer Detection

Type of Directed Biopsy Sensitivity Specificity PPV NPV Accuracy Overall ( n = 115) Gray-scale TRUS 32/63 (51) ⁎ 30/52 (58) ⁎ 32/54 (59) 30/61 (49) 62/115 (54) PDU 36/63 (57) 34/52 (65) ⁎ 36/54 (67) 34/61 (56) 70/115 (61) CETRUS 41/63 (65) 43/52 (83) 41/50 (82) 43/65 (66) 84/115 (73) Serum PSA 4.1–10 ng/ml ( n = 36) Gray-scale TRUS 4/11 (36) 14/25 (56) 4/15 (27) 14/21 (67) 18/36 (50) PDU 5/11 (45) 16/25 (64) 5/14 (36) 16/22 (73) 21/36 (58) CETRUS 6/11 (55) 21/25 (84) 6/10 (60) 21/26 (81) 27/36 (75)

CETRUS: contrast-enhanced transrectal ultrasound; NPV: negative predictive value; PSA: prostate-specific antigen; PDU: power Doppler ultrasound; PPV: positive predictive value; TRUS: transrectal ultrasound.

Data in parentheses are percentages. Sensitivity and specificity of gray-scale TRUS and PDU were compared with those of CETRUS using the χ 2 test.

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Discussion

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Conclusion

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References

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Contrast-enhanced Gray-scale Transrectal Ultrasound-guided Prostate Biopsy in Men with Elevated Serum Prostate-specific Antigen Levels

Rationale and Objectives

Materials and Methods

Results

Conclusions

Materials and methods

Patients

Contrast-Enhanced Transrectal Gray-scale Ultrasonography and Image Analysis

Transrectal Ultrasound-guided Biopsy

Statistical Analysis

Results

Discussion

Conclusion

References

Further Reading

Abstracts of Funded National Institutes of Health Grants

Accurate Automatic Papillary Muscle Identification for Quantitative Left Ventricle Mass Measurements in Cardiac Magnetic Resonance Imaging

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