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Usefulness of perflubutane microbubble-enhanced ultrasound in imaging and detection of prostate cancer: phase II multicenter clinical trial

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Abstract

Purpose

To explore the possibility of targeted biopsy (TBx) using transrectal ultrasound (US) with perflubutane microbubbles, we studied the findings of different cancerous tissue imaging modalities and evaluated needle biopsy in prostate cancer (PCa) using contrast-enhanced US (CEUS) in a multicenter clinical trial.

Methods

Seventy-one patients undergoing prostate biopsy received intravenous injection of perflubutane microbubbles (Sonazoid®). We evaluated and compared images obtained by CEUS. The safety observation period was 2 days after contrast administration.

Results

Among the 30 patients with cancer, one or more sites with findings suggestive of cancer in CEUS were detected in 23 patients (32.4%) by TBx. Although 22 patients had positive cores of cancer by systematic biopsy (SBx), 8 patients had positive cores of cancer in TBx alone (11.3%). There was a significant difference in cancer detection rate by TBx between two cohorts with PSA < 10 ng/mL (22.9%) and PSA ≥ 10 ng/mL (52.2%) (P < 0.02). Close observation of various CEUS findings with Sonazoid® enabled targeting of cancerous areas, and consequently, a significant difference (P < 0.05) in the detection rate of cancer was recognized in the transition zone (TZ): SBx; 21/120 (17.5%) and TBx; 17/55 (30.9%). The incidence of adverse events was 6.7% and that of adverse reactions was 4%.

Conclusions

CEUS with Sonazoid® improved the detection rate of PCa by visualizing cancerous lesions. More detailed examination of CEUS images provided efficient characterization especially in the TZ area. TBx according to this procedure is expected to enable a lower number of biopsies and more accurate diagnosis of PCa.

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References

  1. Chang JJ, Shinohara K, Bhargava V, Presti JC Jr (1998) Prospective evaluation of lateral biopsies of the peripheral zone for prostate cancer detection. J Urol 160(6 Pt 1):2111–2114

    PubMed  CAS  Google Scholar 

  2. Salo JO, Rannikko S, Makinen J, Lehtonen T (1987) Echogenic structure of prostatic cancer imaged on radical prostatectomy specimens. Prostate 10(1):1–9

    Article  PubMed  CAS  Google Scholar 

  3. Heidenreich A, Aus G, Bolla M, Joniau S, Matveev VB, Schmid HP, Zattoni F (2008) EAU guidelines on prostate cancer. Eur Urol 53(1):68–80

    Article  PubMed  Google Scholar 

  4. Roehrborn CG, Pickens GJ, Sanders JS (1996) Diagnostic yield of repeated transrectal ultrasound-guided biopsies stratified by specific histopathologic diagnoses and prostate specific antigen levels. Urology 47(3):347–352

    Article  PubMed  CAS  Google Scholar 

  5. Halpern EJ, Frauscher F, Rosenberg M, Gomella LG (2002) Directed biopsy during contrast-enhanced sonography of the prostate. AJR Am J Roentgenol 178(4):915–919

    Article  PubMed  Google Scholar 

  6. Halpern EJ, McCue PA, Aksnes AK, Hagen EK, Frauscher F, Gomella LG (2002) Contrast-enhanced US of the prostate with Sonazoid: comparison with whole-mount prostatectomy specimens in 12 patients. Radiology 222(2):361–366

    Article  PubMed  Google Scholar 

  7. Forsberg F, Liu JB, Burns PN, Merton DA, Goldberg BB (1994) Artifacts in ultrasonic contrast agent studies. J Ultrasound Med 13(5):357–365

    PubMed  CAS  Google Scholar 

  8. Sano F, Terao H, Kawahara T, Miyoshi Y, Sasaki T, Noguchi K, Kubota Y, Uemura H (2011) Contrast-enhanced ultrasonography of the prostate: various imaging findings that indicate prostate cancer. BJU Int 107(9):1404–1410

    Article  PubMed  Google Scholar 

  9. Matsumoto K, Nakagawa K, Hashiguchi A, Kono H, Kikuchi E, Nagata H, Miyajima A, Oya M (2010) Contrast-enhanced ultrasonography of the prostate with Sonazoid. Jpn J Clin Oncol 40(11):1099–1104

    Article  PubMed  Google Scholar 

  10. Mitterberger MJ, Aigner F, Horninger W, Ulmer H, Cavuto S, Halpern EJ, Frauscher F (2010) Comparative efficiency of contrast-enhanced colour Doppler ultrasound targeted versus systematic biopsy for prostate cancer detection. Eur Radiol 20(12):2791–2796

    Article  PubMed  Google Scholar 

  11. Al-Ahmadie HA, Tickoo SK, Olgac S, Gopalan A, Scardino PT, Reuter VE, Fine SW (2008) Anterior-predominant prostatic tumors: zone of origin and pathologic outcomes at radical prostatectomy. Am J Surg Pathol 32(2):229–235

    Article  PubMed  Google Scholar 

  12. Haarer CF, Gopalan A, Tickoo SK, Scardino PT, Eastham JA, Reuter VE, Fine SW (2009) Prostatic transition zone directed needle biopsies uncommonly sample clinically relevant transition zone tumors. J Urol 182(4):1337–1341

    Article  PubMed  Google Scholar 

  13. Patel V, Merrick GS, Allen ZA, Andreini H, Taubenslag W, Singh S, Butler WM, Adamovich E, Bittner N (2011) The incidence of transition zone prostate cancer diagnosed by transperineal template-guided mapping biopsy: implications for treatment planning. Urology 77(5):1148–1152

    Article  PubMed  Google Scholar 

  14. Jack GS, Cookson MS, Coffey CS, Vader V, Roberts RL, Chang SS, Smith JA Jr, Shappell SB (2002) Pathological parameters of radical prostatectomy for clinical stages T1c versus T2 prostate adenocarcinoma: decreased pathological stage and increased detection of transition zone tumors. J Urol 168(2):519–524

    Article  PubMed  Google Scholar 

  15. Davis JW, Kim J, Ward JF, Wang X, Nakanishi H, Babaian RJ, Troncoso P (2010) Radical prostatectomy findings in patients predicted to have low-volume/low-grade prostate cancer diagnosed by extended-core biopsies: an analysis of volume and zonal distribution of tumour foci. BJU Int 105(10):1386–1391

    Article  PubMed  Google Scholar 

  16. Hodge KK, McNeal JE, Terris MK, Stamey TA (1989) Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol 142(1):71–74; (discussion 74–75)

    Google Scholar 

  17. Babaian RJ, Toi A, Kamoi K, Troncoso P, Sweet J, Evans R, Johnston D, Chen M (2000) A comparative analysis of sextant and an extended 11-core multisite directed biopsy strategy. J Urol 163(1):152–157

    Article  PubMed  CAS  Google Scholar 

  18. Liu IJ, Macy M, Lai YH, Terris MK (2001) Critical evaluation of the current indications for transition zone biopsies. Urology 57(6):1117–1120

    Article  PubMed  CAS  Google Scholar 

  19. Smeenge M, Mischi M, Laguna Pes MP, De la Rosette JJ, Wijkstra H (2011) Novel contrast-enhanced ultrasound imaging in prostate cancer. World J Urol 29(5):581–587

    Article  PubMed  Google Scholar 

  20. Fischer T, Thomas A, Tardy I, Schneider M, Hunigen H, Custodis P, Beyersdorff D, Plendl J, Schnorr J, Diekmann F, Gemeinhardt O (2010) Vascular endothelial growth factor receptor 2-specific microbubbles for molecular ultrasound detection of prostate cancer in a rat model. Invest Radiol 45(10):675–684

    Article  PubMed  CAS  Google Scholar 

  21. Pochon S, Tardy I, Bussat P, Bettinger T, Brochot J, Von Wronski M, Passantino L, Schneider M (2010) BR55: a lipopeptide-based VEGFR2-targeted ultrasound contrast agent for molecular imaging of angiogenesis. Invest Radiol 45(2):89–95

    Article  PubMed  CAS  Google Scholar 

  22. Eggener S, Salomon G, Scardino PT, De la Rosette J, Polascik TJ, Brewster S (2010) Focal therapy for prostate cancer: possibilities and limitations. Eur Urol 58(1):57–64

    Article  PubMed  Google Scholar 

  23. Zaytoun OM, Moussa AS, Gao T, Fareed K, Jones JS (2011) Office based transrectal saturation biopsy improves prostate cancer detection compared to extended biopsy in the repeat biopsy population. J Urol 186(3):850–854

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Prof. Fuminori Moriyasu (Tokyo Medical University) for useful suggestions.

Conflict of interest

Funding for this study was provided by Daiichi Sankyo Co., Ltd. Authors who were not employees of the sponsor controlled the inclusion of any data and information that might have presented a conflict of interest for employees of the sponsor.

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Authors and Affiliations

  1. Department of Urology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan

    Hiroji Uemura, Futoshi Sano & Yoshinobu Kubota

  2. Department of Urology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan

    Akira Nomiya & Yukio Homma

  3. Department of Urology, School of Medicine, Tokyo Jikei University, Tokyo, Japan

    Toshihiro Yamamoto, Kenta Miki & Shin Egawa

  4. Department of Urology, Yokohama City University Medical Center, Yokohama, Japan

    Masafumi Nakamura, Yasuhide Miyoshi & Kazumi Noguchi

Authors
  1. Hiroji Uemura
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  2. Futoshi Sano
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  3. Akira Nomiya
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  4. Toshihiro Yamamoto
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  5. Masafumi Nakamura
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  6. Yasuhide Miyoshi
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  7. Kenta Miki
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  8. Kazumi Noguchi
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  9. Shin Egawa
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  10. Yukio Homma
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  11. Yoshinobu Kubota
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Corresponding author

Correspondence to Hiroji Uemura.

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Uemura, H., Sano, F., Nomiya, A. et al. Usefulness of perflubutane microbubble-enhanced ultrasound in imaging and detection of prostate cancer: phase II multicenter clinical trial. World J Urol 31, 1123–1128 (2013). https://doi.org/10.1007/s00345-012-0833-1

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  • DOI: https://doi.org/10.1007/s00345-012-0833-1

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