The value and limitations of contrast-enhanced transrectal ultrasonography for the detection of prostate cancer
Introduction
Prostate cancer is a common malignancy in older males in Western countries [1]. This type of tumor was considered to have lower incidence rates in China in the past. However, the trend has changed in recent decades, with an increase of 13.4% in the incidence rate of prostate cancer per year from 1994 to 2002 and an increase in the mortality rate by 1.8% per year from 1985 to 2009 [2].
Transrectal ultrasonography (TRUS) has widely been used for evaluating the prostate and guiding biopsy. However, many previous studies demonstrated that TRUS was of limited value for detecting prostate cancer owing to its unsatisfactory sensitivity and variable accuracy [3], [4], [5]. Contrast-enhanced transrectal ultrasonography (CE-TRUS) that can enhance the visualization of perfusion changes related to prostate cancer is regarded as a promising tool for improving the detection of prostate cancer. Several previous studies demonstrated that employing CE-TRUS and lesion-targeted biopsy improved the detection of prostate cancer [6], [7]. To date, however, there have been few reports regarding which prostate lesions may produce false-positive and false-negative results related to CE-TRUS. Furthermore, the detection of prostate cancer with CE-TRUS has not been analyzed in correlation with serum prostate specific antigen (PSA) level, which is an important marker for detecting the early lesion and monitoring the progression of prostate cancer.
The first aim of this study is to evaluate the role of CE-TRUS for the detection of prostate cancer, and analyze false-positive and false-negative results compared with the pathological findings of biopsy or radical prostatectomy. Another purpose is to explore the relationship between cancerous detection with CE-TRUS and serum PSA levels.
Section snippets
Patients
From October 2009 to November 2010, 65 patients who were clinically suspected of having prostate cancer owing to elevated serum prostate-specific antigen levels (PSA ≥ 4 ng/ml) and/or abnormal digital rectal examination (DRE) were enrolled in this study. The mean patient age was 71.9 years (range: 58–88 years). Of the 65 patients, 55 only had elevated PSA levels, three presented with abnormal DRE and the other seven patients had both elevated PSA levels and abnormal DRE. PSA levels were divided
Results
No side-effects related to the contrast agent were observed in this study. Twenty-nine patients were pathologically diagnosed as having prostate cancer, with the mean Gleason score of 6.9 (range 3–9), and 36 were diagnosed as having benign prostatic hyperplasia. Of the 29 patients with prostate cancer, 27 were detected by transrectal ultrasound guided biopsy and two were missed by this technique and then found by transurethral resection of the prostate. These patients subsequently underwent
Discussion
The results of this study demonstrated that CE-TRUS had a significant advantage over baseline TRUS for detecting prostate cancer through observing CE-TRUS images and selecting an appropriate biopsy site.
In the present study, we evaluated the visualization of prostate cancer by CE-TRUS and TRUS, and compared them with pathological findings in patients who underwent biopsy and/or radical prostatectomy. The majority of prostate cancers could be detected at the sites where lesions were suspected by
Conclusion
In conclusion, CE-TRUS may improve the detection rate of prostate cancer by targeted biopsy of contrast-enhanced abnormalities. On the basis of that prostate cancer originating from the TZ and the PZ with low PSA level, small-size foci, and moderately or well-differentiated lesions can be missed by CE-TRUS, systematic biopsies should not be eliminated.
Conflict of interest
We declare that there are no conflicts of interest between the authors and the hospital, industry or any other relevant institutions.
References (31)
- et al.
International variation in prostate cancer incidence and mortality rates
European Urology
(2012) - et al.
Contrast enhanced ultrasound flash replenishment method for directed prostate biopsies
Journal of Urology
(2007) - et al.
The safety of Sonovue in abdominal applications: retrospective analysis of 23188 investigations
Ultrasound in Medicine and Biology
(2006) - et al.
Contrast enhanced color Doppler endorectal sonography of prostate: efficiency for detecting peripheral zone tumours and role for biopsy procedure
Journal of Urology
(2003) - et al.
Non-invasive diagnosis of hepatic cirrhosis by transit-time analysis of an ultrasound contrast agent
Lancet
(1999) - et al.
Pathological parameters of radical prostatectomy for clinical stages T1c versus T2 prostate adenocarcinoma: decreased pathological stage and increased detection of transition zone tumours
Journal of Urology
(2002) - et al.
Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate
Journal of Urology
(1989) - et al.
Comparison of contrast enhanced color doppler targeted biopsy to conventional systematic biopsy: impact on Gleason score
Journal of Urology
(2007) - et al.
Contrast enhanced transrectal ultrasound for the detection of prostate cancer: a randomized, double-blind trial of dutasteride pretreatment
Journal of Urology
(2012) - et al.
Global cancer statistics
CA: A Cancer Journal for Clinicians
(2011)
Prostate cancer and the role of color Doppler US
Radiology
Prostatic cancer: role of color Doppler imaging in transrectal sonography
American Journal of Roentgenology
Initial experience with contrast-enhanced sonography of the prostate
American Journal of Roentgenology
Prostate cancer: contrast-enhanced US for detection
Radiology
Microvessel density: correlation between contrast ultrasonography and histology of prostate cancer
European Urology
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