Elsevier

European Journal of Radiology

Volume 82, Issue 11, November 2013, Pages e641-e647
European Journal of Radiology

The value and limitations of contrast-enhanced transrectal ultrasonography for the detection of prostate cancer

https://doi.org/10.1016/j.ejrad.2013.07.004Get rights and content

Abstract

Objectives

To evaluate the role of contrast-enhanced transrectal ultrasonography (CE-TRUS) for detecting prostate carcinoma.

Methods

Sixty-five patients with elevated serum prostate-specific antigen (PSA) and/or abnormal digital rectal examination (DRE) were assessed using transrectal ultrasound (TRUS) and CE-TRUS. In all the patients, CE-TRUS was performed with intravenous injection of contrast agent (SonoVue, 2.4 ml) before biopsy. The cancer detection rates of the two techniques were compared. False-positive and false-negative findings related to CE-TRUS were analyzed in comparison to the pathological results of biopsy or radical prostatectomy. The targeted biopsy to abnormal CE-TRUS areas was also compared to systematic biopsy.

Results

Prostate cancer was detected in 29 of the 65 patients. CE-TRUS showed rapid focal enhancement or asymmetric vessels of peripheral zones in 28 patients; 23 of them had prostate cancer. CE-TRUS had 79.3% sensitivity, compared to 65.5% of TRUS (P < 0.05). There were five false-positive and six false-negative findings from CE-TRUS. Benign prostate hyperplasia, and acute and chronic prostatitis were important causes related to the false-positive results of CE-TRUS. Prostate cancer originating from the transition zone or peripheral zone with lower PSA levels, small-size foci, and moderately or well-differentiated tumor was missed by CE-TRUS. The cancer detection rate of targeted biopsy (75%, 33/44 cores) was significantly higher than one of systematic biopsy (48.2%, 162/336) in those 28 cases (P < 0.05). In addition, no significant correlation was found between the cancer detection rate with CE-TRUS and serum PSA levels.

Conclusion

CE-TRUS may improve the detection rate of prostate cancer through targeted biopsy of contrast-enhanced abnormalities. Our findings indicate that systematic biopsies should not be eliminated on the basis of false-positive and false-negative findings related to CE-TRUS.

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.

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