2019 CONTRAST ENHANCED ULTRASOUND FOR THE DETECTION OF PROSTATE CANCER: DO TARGETED BIOPSIES RESULT IN MORE ACCURATE CLINICAL STAGING?

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology (I)1 Apr 20132019 CONTRAST ENHANCED ULTRASOUND FOR THE DETECTION OF PROSTATE CANCER: DO TARGETED BIOPSIES RESULT IN MORE ACCURATE CLINICAL STAGING? Douglas Kelly, Jessica Jackson, James Mark, Ethan Halpern, Flemming Forsberg, Peter McCue, Edouard Trabulsi, and Leonard Gomella Douglas KellyDouglas Kelly Philadelphia, PA More articles by this author , Jessica JacksonJessica Jackson Philadelphia, PA More articles by this author , James MarkJames Mark Philadelphia, PA More articles by this author , Ethan HalpernEthan Halpern Philadelphia, PA More articles by this author , Flemming ForsbergFlemming Forsberg Philadelphia, PA More articles by this author , Peter McCuePeter McCue Philadelphia, PA More articles by this author , Edouard TrabulsiEdouard Trabulsi Philadelphia, PA More articles by this author , and Leonard GomellaLeonard Gomella Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2438AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Contrast enhanced ultrasound (CEUS) using Doppler detection and microbubble contrast helps identify hypervascular prostate cancers. We hypothesize that targeted biopsies using CEUS may lead to more accurate clinical staging. METHODS We reviewed biopsy results of 272 consecutive patients enrolled in a CEUS targeted prostate biopsy trial. Patients underwent up to 6 directed biopsies followed by a standard 12 core biopsy. The standard 12 core biopsy was performed by a blinded investigator not present at the time of the targeted biopsies. Biopsy results were analyzed to determine if directed biopsies resulted in an increased NCCN risk classification for each patient diagnosed with prostate cancer. RESULTS Of the 272 patients enrolled in the study, 262 patient charts were available for review. Of the 262 patients included in our analysis 111 were diagnosed with prostate cancer. Of the 111 prostate cancers, 25 (22%) of the cancers were upgraded with directed biopsies. Patients were then analyzed separately in four groups: Patients with no previous biopsies (n=112); Patients with a previous negative biopsy (n =61); Patients with a previous positive biopsy (n=54); Patients with a previous biopsy positive for ASAP or PIN (n = 35). Cancer was diagnosed in 55 (49%), 13 (21%), 33 (61%) and 10 (29%) patients in each group respectively. Of these cancers 10 (18%), 5 (38%), 8 (24%) and 2 (20%) were upgraded respectively. CONCLUSIONS CEUS targeted biopsies upgraded 22% of prostate cancers diagnosed. CEUS may more accurately determine which patients with prostate cancer need aggressive treatment vs. active surveillance. CEUS may be specifically useful for patients with a previous negative biopsy. 38% of patients with a previous negative biopsy were upgraded with directed biopsies. CEUS targeted biopsies may target lesions at the apex or transition zone, areas often missed by a standard biopsy. Results of Subgroup Analysis No previous biopsy Previous negative biopsy Previous biopsy positive for cancer Previous biopsy positive for ASAP/PIN Total 112 61 54 35 Average PSA 6.6 9.2 4.7 5.7 Positive for Cancer 55 13 33 10 Percent Positive for Cancer 49% 21% 61% 29% Positive for Cancer only in directed biopsy 4 2 4 1 Positive for Cancer only in systematic 17 6 19 5 Positive for Cancer in both 34 5 10 4 Patients upgraded 10 5 8 2 Percent upgraded 18% 38% 24% 20% © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e829 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Douglas Kelly Philadelphia, PA More articles by this author Jessica Jackson Philadelphia, PA More articles by this author James Mark Philadelphia, PA More articles by this author Ethan Halpern Philadelphia, PA More articles by this author Flemming Forsberg Philadelphia, PA More articles by this author Peter McCue Philadelphia, PA More articles by this author Edouard Trabulsi Philadelphia, PA More articles by this author Leonard Gomella Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...