Detection Of Prostate Carcinoma Research Articles

MR-based biomarkers in the diagnosis and the evaluation of the therapeutic response to radiotherapy (ETRR) in prostatic carcinoma (PCa): Implementation of clinical and experimental approaches

e16136 Background: ETRR in PCa remains a challenging task. New biomarkers in the form of metabolites, detected with Proton Magnetic Resonance Spectroscopy (1H-MRS), and quantitative Apparent Diffusion Coefficient (ADC), determined with Diffusion-Weighted Magnetic Resonance Imaging, could be of value in the ETRR for PCa. Methods: Twenty-one men with biopsy proven localized PCa were examined before external radiotherapy. 3D-1H-MRS was performed at 3.0T without endorectal coils. The delivered radiotherapy dose was 78 Gy in 39 fractions with 6 MV photons. MR follow-up examinations up to 36 months post-radiotherapy were performed. For the pre-clinical study, healthy rat prostate was studied in 3 nude rats. PC3-MM2 and PAC-120 tumors were subcutaneously (SC) and orthotopically (OT) xenografted in 5 nude rats, respectively. Radiotherapy anti-tumor efficacy administered as HDR-brachytherapy (SC) or X6 external beam irradiation (OT) delivering 10 Gy/5 fractions was evaluated. 1H-MRS was performed at 4.7 T using SVS. Results: Twelve men received the 3-month examination, 8 patients are at 6-months, 4 are at 9 months and 1 has been followed for 1 year. At baseline, healthy prostate shows a low Choline (Cho)/Citrate ratio, whereas the presence of cancer considerably increases this ratio. At 3 months, we observed metabolic atrophy except for Cho. Although, higher ADC values are normally found in peripheral zone than in central gland, these differences disappear after radiotherapy. In healthy rat prostate high levels of Cho without citrate were noted. Cho and free lipids were detected in PC3-MM2 and PAC120 SC-grafted tumors, with a higher Cho content in PC3-MM2. Radiotherapy induced significant antitumor activity in PC3-MM2 (SC) (T/C% = 38%) and OT (ILS% = 58%) tumors, but was not efficient in PAC120 SC-grafted tumors (T/C% = 90%). Radiotherapy slightly modified Cho content 4 days after the end of treatment but no modification on overall metabolic profile was observed before, during and after radiotherapy. Conclusions: Combined ADC and Cho are powerful biomarkers for the detection of PCa in men and could be useful for ETRR.The use of Cho in ETRR for PCa in rats appears to be promising. No significant financial relationships to disclose.

The role of dynamic contrast enhanced MRI in the detection of recurrent prostate carcinoma after external beam radiotherapy-correlation with transrectal ultrasound and pathological findings

To assess the effectiveness of dynamic contrast-enhanced (DCE) T1- and T2-weighted magnetic resonance imaging (MRI) during the follow-up of patients with prostate cancer after undergoing external beam radiotherapy (EBRT) and to compare these imaging findings to pathological and transrectal ultrasound (TRUS) findings. In this retrospective study, the MRI findings of 20 patients who had prostate cancer and were treated with EBRT were evaluated to detect tumor recurrence. The MRI findings were compared to those that had been obtained by TRUS and pathological analysis. The sensitivity and specificity of TRUS in the detection of tumor recurrence in patients who had undergone EBRT were 53.3% and 60%, respectively. In the same group of patients, the sensitivity and specificity of T2-weighted MRI were 86% and 100%, respectively. Strikingly, the sensitivity and specificity of DCE T1-weighted MRI in the diagnosis of recurrent prostate cancer were 93% and 100%, respectively. The accuracy of the DCE T1-weighted images in the detection of recurrence was significantly higher in comparison to that obtained using T2-weighted images. During the follow-up of these patients, TRUS without the use of any other imaging or biochemical modality is not a sufficient method for the detection of prostate cancer recurrence. DCE T1-weighted MRI increases the sensitivity of MRI alone for the detection of recurrence during the follow-up of prostate cancer patients who have been treated with EBRT. Thus, DCE T1-weighted MRI must be used as part of the routine MRI analysis to check for tumor recurrence in patients with prostate cancer.

PCA3 Urine mRNA Testing for Prostate Carcinoma: Patterns of Use by Community Urologists and Assay Performance in Reference Laboratory Setting

Multiple trials have shown the high specificity of urine prostate cancer gene 3 (PCA3) compared with serum prostate-specific antigen (PSA) for biopsy detection of prostate carcinoma. We characterized the patterns of use of PCA3 by community urologists and determined the performance of PCA3 testing as a laboratory-developed test in a reference laboratory setting. The urine PCA3 and PSA mRNA levels after digital rectal examination were determined using transcription-mediated amplification. The cutoff for a positive PCA3 score (PCA3/PSA mRNA x 10(3)) were pre-established at > or = 35. The PCA3 results were correlated with the serum PSA level, previous biopsy history, and the prostate biopsy findings. A total of 278 PCA3 tests were performed from December 2006 to June 2007. Of the PCA3 tested patients, 55.5% had previously undergone > or = 1 prostate biopsy; 92.7% had a PSA level > or = 2.5 ng/mL. The PCA3 test informative rate was 97.5%. For 50 samples that were also analyzed at a separate laboratory, concordance was achieved in 94%. The mean and median PCA3 score was 44.3 and 21.1, respectively. No correlation was found with the serum PSA level. The PCA3 test was negative in 16 of 19 patients with negative concurrent biopsy findings and positive in 8 of 11 with positive concurrent biopsy findings (sensitivity 72.7% and specificity 84.2%). Of 32 patients (70% with previous biopsy) who had undergone biopsy an average of 56 days after positive PCA3 test results, prostate carcinoma was detected in 41%. Urine PCA3 testing on the transcription-mediated amplification platform performed well as a laboratory-developed test. The high specificity of PCA3 was confirmed. In patients with elevated PSA levels and negative biopsy findings, PCA3 testing might be useful in choosing between repeat biopsy and more conservative follow-up.

Sonohistology – Ultrasonic tissue characterization for prostate cancer diagnostics

A computer-aided diagnostic system for imaging prostate cancer has been developed in order to supplement today's conventional methods for the early detection of prostate carcinoma. The system is based on analysis of the spectral content of radiofrequency ultrasonic echo data in combination with evaluations of textural, contextual, morphological and clinical features in a multiparameter approach. A state-of-the-art, non-linear classifier, the so-called adaptive network-based fuzzy inference system, is used for higher-order classification of the underlying tissue-describing parameters. The system has been evaluated on radio-frequency ultrasound data originating from 100 patients using histological specimens obtained after prostatectomy as the gold standard. Leave-one-out cross-validation over patient data sets results in areas under the ROC curve of 0.86 +/- 0.01 for hypoechoic and hyperechoic tumors and of 0.84 +/- 0.02 for isoechoic tumors, respectively.

Behandlung von spezifischen Komplikationen des lokal fortgeschrittenen Prostatakarzinoms

Despite improved screening methods and earlier detection of prostate carcinoma, the complications of locally advanced disease remain a challenge for urologists. The spectrum of possible complications includes subvesical obstruction, hydronephrosis, hematuria, pain, and local invasion of adjacent organs. Urinary diversion, palliative transurethral resection of the prostate, and endoscopic diathermy are classic procedures. Urethral stenting, laser evaporation, and selective arterial embolization are alternate approaches for treating these complex cases. Cystoprostatectomy and pelvic exenteration are ultimate options for patients with chronic pain and debilitating local symptoms.

Serum prostate-specific antigen, radiologic findings and Gleason score in prostate biopsies in Jordan

Prostate-specific antigen (PSA) and the PSA ratio are good screening tests for prostate carcinoma. The significance of PSA may be different from one ethnic group to another. Radiologic findings may be helpful in detecting prostate carcinoma. We reviewed the findings of 348 prostate biopsies performed in a 4-year period. Of these, 278 cases were performed under ultrasound guidance and 70 were performed transrectally under digital guidance. PSA, PSA ratio, Gleason score and radiology findings were determined. Forty-three percent of the cases were diagnosed as having adenocarcinoma. The mean age for cancer patients was 68.4 years. The mean PSA level for patients with carcinoma was 23.4 ng/mL compared to 11.2 ng/mL for benign cases. Carcinoma occurred in 11% (PSA <4 ng/mL); 48.7% (PSA=4-10 ng/mL); 50.6% (PSA= 10-30 ng/mL); 72% (PSA >30 ng/mL). The PSA ratio for cancer cases was 9.9% compared to 13.7% for benign cases. The average Gleason score for all cancers was 7 of 10. There was no relationship between PSA level and Gleason score. The higher the Gleason score, the higher the percentage of carcinoma present in the cores. Most of the carcinomas (100/122) showed hypoechoic areas on ultrasound exam, while heterogeneous areas favored a benign lesion in 54/76, with a sensitivity of 82% and specificity of 38%. The higher the PSA, the greater the chance of having cancer. PSA has a low positive predictive value for prostate carcinoma. Twenty-eight percent of PSA >30 can be attributed to benign conditions. A PSA ratio <10 is suggestive of carcinoma. A radiologic finding of a hypoechoic lesion is a sensitive tool for detecting prostate carcinoma, but its specificity is low.

PSMA expression in Schwannoma: A potential clinical mimicker of metastatic prostate carcinoma

Objectives Radioimmunoscintigraphy using a radiolabeled antibody against prostate-specific membrane antigen (PSMA) is frequently used to detect prostate carcinoma (PCa) recurrence and metastasis to lymph nodes, soft tissues, and bone. PSMA expression has been shown in occasional nonprostatic neoplasms (e.g., urothelial adenocarcinoma) and in the vasculatures of other malignancies. PSMA expression has not been described in benign neoplasms. Recently, during evaluation of a prostatic carcinoma patient, we encountered a false positive PSMA radioimmunoscintigraphy scan in a pathologically confirmed Schwannoma (SCH) lesion. The current study further evaluates PSMA expression in Schwannomas. Methods Eleven SCH were retrieved from our surgical pathology archives. Representative sections were immunostained with monoclonal antibody for PSMA. PSMA expression was evaluated in tumor cells and lesional vessels. Extent of staining was calculated as percent of positive cells in highest areas of expression. Positive staining was considered focal, multifocal, or diffuse based on the percent of positive cells: <5%, 5% to 75%, and >75%, respectively. Results All 11 SCH showed tumoral and or vascular staining; 7 (7/11) displayed both vascular and tumoral cell staining; the remaining 4 had only vascular staining (2/11) or tumor cell staining (2/11). The extent of tumoral cell and vascular staining varied widely among lesions (tumor cells: focal in 8 and diffuse in 1; vascular: focal in 7, multifocal in 1, and diffuse in 1 lesion). Conclusion This is the first report of PSMA expression in a benign neoplasm. Given our finding of frequent expression of PSMA in Schwannomas, they should be clinically considered in the differential diagnosis of a lesion that is positive on PSMA radioimmunoscintigraphy study performed during a metastatic work-up of PCa patient.

Role of Colour Doppler Imaging in Detecting Prostate Cancer

This prospective study was undertaken to evaluate the role of colour Doppler sonography in the assessment of prostate carcinoma. Forty consecutive patients who were suspected of having prostate carcinoma with either raised prostate specific antigen or abnormal digital rectal examination were included in the study. Transrectal greyscale and colour Doppler sonography of the prostate was performed using a 5-9 MHz intracavitary probe. Needle biopsies were taken from areas that showed increased flow on colour Doppler. The results were correlated with the final diagnosis established on histopathological examination. Comparison of greyscale and colour Doppler sonography showed that the latter is more sensitive and specific in predicting the malignancy. The statistical parameters of colour Doppler versus grayscale sonography were: sensitivity 88.23 vs. 73.52, specificity 66.66 vs. 33.33, positive predictive value 93.75 vs. 85.18, and negative predictive value 50 vs. 22.22, respectively. Colour Doppler and greyscale sonography should be routinely performed to improve detection of prostate carcinoma and to target the lesion.

Usefulness of apparent diffusion coefficient map in diagnosing prostate carcinoma: Correlation with stepwise histopathology

To elucidate the performance of apparent diffusion coefficient (ADC) map in localizing prostate carcinoma (PC) using stepwise histopathology as a reference. Preoperative MR images of 37 patients with PC who had undergone radical prostatectomy were retrospectively evaluated. First, T2-weighted images (T2WI) alone were interpreted (T2WI reading), and then T2WI along with ADC map were interpreted (T2WI/ADC map reading). Sextant-based sensitivity and specificity, and the ratio of the detected volume to the whole tumor volume (% tumor volume) were compared between the two interpretations, and results were also correlated to Gleason's scores (GS). ADC values were correlated to histological grades. Sensitivity was significantly higher in T2WI/ADC map reading than in T2WI reading (71% vs. 51%), but specificity was similar (61% vs. 60%). By adding ADC map to T2WI, % tumor volume detected increased significantly in transitional zone (TZ) lesions, but not in peripheral zone (PZ) lesions. % tumor volume detected with T2WI/ADC map reading showed a positive correlation with GS of the specimens. Less differentiated PC were associated with lower ADC values and higher detectability. T2WI/ADC map reading was better than T2WI reading in PC detection and localization. This approach may be particularly useful for detecting TZ lesions and biologically aggressive lesions.

Comparison of Contrast Enhanced Color Doppler Targeted Biopsy to Conventional Systematic Biopsy: Impact on Gleason Score

Prostate cancer grading with Gleason score is an important prognostic factor. This prospective randomized study compares ultrasound systematic biopsy vs contrast enhanced color Doppler targeted biopsy for the impact on Gleason score findings. We examined 690 men (mean age 56 years, range 41 to 77) with a serum total prostate specific antigen of 1.25 ng/ml or greater, a free-to-total prostate specific antigen ratio less than 18% and/or a suspicious digital rectal examination. Contrast enhanced color Doppler targeted biopsies with a limited number of cores (5 or less) were performed in hypervascular areas of the peripheral zone during administration of the ultrasound contrast agent Sonovuetrade mark (Bracco, Milano, Italy). Ten systematic biopsies were obtained in a standard spatial distribution. Cancer detection rates and Gleason score were compared. Prostate cancer was identified in 221 of 690 subjects (32%) with a mean prostate specific antigen of 4.6 ng/ml (range 1.4 to 35.0). Prostate cancer was detected in 180 of 690 subjects (26%) with contrast enhanced color Doppler targeted biopsy and in 166 of 690 patients (24%) with systematic ultrasound biopsy. The Gleason score of all 180 cancers detected on contrast enhanced color Doppler targeted biopsy was 6 or higher (mean 6.8). The Gleason score of all 166 cancers detected on systematic biopsy ranged from 4 to 6 and mean Gleason score was 5.4. Contrast enhanced color Doppler targeted biopsy detected significantly higher Gleason scores compared to systematic biopsy (Wilcoxon rank sum test p <0.003). Contrast enhanced color Doppler targeted biopsy detected cancers with higher Gleason scores and more cancer than systematic biopsy. Therefore, contrast enhanced color Doppler seems to be helpful in the grading of prostate cancer, which is important for defining prognosis and deciding treatment.

The significance of TPSA, free to total PSA ratio and PSA density in prostate carcinoma diagnostics

Prostate-specific antigen (PSA) is the one of the most valuable tumor markers for the early detection and management of prostate carcinoma, but not an ideal one because of poor specificity in the case of prostatic hypertrophy and other benign conditions. In order to overcome this drawback some other parameters as is free to total ratio (F/T) PSA and PSA density (PSAD) are introduced. It has been investigated in 60 patients, 18 of them are proved to be found prostate cancer and other 42 were identified as benign prostatic hyperplasia. Patients with CaP had TPSA median of 11.4 ng/ml and the others with benign prostatic hyperplasia (BPH) had 6.9 ng/ml. In these two groups there was statistical significant difference (p 0.01). By receiver operating characteristics curve (ROC) estimated cutoff for TPSA was 4.0 ng/ml with 95% sensitivity, 30% specificity and area covered by ROC was in amount of 0.76. Median F/T ratio for patients with prostate cancer was 0.10, and for benign prostatic hyperplasia patients it was 0.25. For these values there is also statistical difference (p). Using ROC cutoff for F/T PSA was determined at the value of 0.18 with sensitivity 95%, specificity 80% and area under the curve (AUC) 0.93. Median for PSAD in the group with CaP was 0.38 and in the BPH group was 0.16. There was statistical significance within those two groups. In conclusion F/T PSA, PSAD and TPSA are valuable tumor markers in distinguishing patients with CaP ant those without with modestly raised TPSA. Also F/T PSA showed up as better marker than TPSA and PSAD in investigated group of patients.

Hypermethylation of the CpG islands in the promoter region flanking GSTP1 gene is a potential plasma DNA biomarker for detecting prostate carcinoma

Objectives: To investigate the possibility of identifying DNA hypermethylation in the circulation of prostate cancer patients. Methods: Plasma DNA samples were extracted from 36 prostate cancer patients and 27 benign prostate hyperplasia (BPH) cases. After extensive methylation-sensitive restriction enzyme digestion, the DNA samples were subjected to the real-time quantitative PCR amplification. Dissociation curve analysis was applied to determine if hypermethylation occurred in the promoter region flanking the GSTP1 gene, a well-documented epigenetic event among prostate cancer cells, in these plasma DNA samples. Results: 11 of 36 prostate cancer patients showed positive peak pattern, indicating methylation changes occurred. Concordant data were obtained from the corresponding paraffin-embedded tissue samples available from the Tumor Bank. Twenty-five of the 27 BPH cases showed negative results, suggesting no methylation changes happened in the CpG islands in these cases. Conclusions: We have successfully identified prostate cancer genome hypermethylation in the peripheral circulation in prostate cancer patients with this protocol. This method can effectively distinguish BPH from prostate neoplasm. Although a larger number of samples are necessary to validate the capability of the protocol in practice, using plasma DNA sample is an ideal non-invasive approach for prostate neoplasm detection.

Sensitivity of P504S/??-Methylacyl-CoA Racemase (AMACR) Immunohistochemistry for the Detection of Prostate Carcinoma on Stored Needle Biopsies

Alpha methylacyl-CoA-racemase (AMACR), also known as P504S, has been widely used as a positive marker for the diagnosis of prostate carcinoma in clinical practice. The utility of this assay is highly dependent on the sensitivity of AMACR detection in routinely processed biopsies. It is common practice to store precut prostate biopsy sections. Hence, it is important to determine the effect on the immunoreactive of P504S/AMACR in stored, unstained glass slides as compared with freshly cut sections of paraffin-embedded tissue. The purpose of this study was to determine the sensitivity of AMACR immunostaining for the detection of prostate carcinoma on stored needle biopsies. A total of 63 prostate biopsies with prostate carcinoma were transferred onto glass slides, baked, and stored for 1.6 to 9.2 months. The Gleason scores were 3+3(6) (n=40) including 10 small focal carcinomas (< or = 1.0 mm), 4+3(7) (n=16), and 4+4(8) or higher (n=7). The slides were then stained with a monoclonal antibody to P504S, and the staining intensity was compared with sections cut from the same blocks just prior to immunostaining, without an intervening storage period. There was no loss of sensitivity of AMACR for prostate adenocarcinoma, regardless of the length of the storage interval. The sensitivity was preserved and was independent of Gleason scores. The sensitivity of AMACR for small foci of adenocarcinoma was also not affected by the length of storage. Overall, stored slides had no observable increase in nonspecific background staining over freshly cut sections. These results indicate that the time interval between mounting and staining does not affect the sensitivity of the AMACR immunohistochemistry (IHC) stain in the detection of prostate cancer even with small foci of carcinoma on needle biopsies.

Detection of prostate cancer by α‐methylacyl CoA racemase (P504S) in needle biopsy specimens previously reported as negative for malignancy

To investigate the possibility of detecting small focal prostatic cancer by alpha-methylacyl CoA racemase (AMACR)/P504S immunohistochemistry on needle biopsy specimens that were previously interpreted as negative for carcinoma on routine haematoxylin and eosin (H&E)-stained sections. Prostate needle biopsy specimens (n = 793) previously interpreted as benign prostatic tissue by conventional morphology from 239 patients with prostatic cancer diagnosed in other biopsy cores taken at the same biopsy session were stained with the P504S monoclonal antibody. If a biopsy specimen stained positively, two pathologists independently reviewed the original corresponding H&E-stained sections to establish the malignant diagnosis. Eighty-four of the 793 biopsy specimens showed AMACR immunoreactivity; nine of these (9/793, 1.1%) contained previously unrecognized small focal prostatic carcinoma (Gleason 6, N = 8; Gleason 8, N = 1). Six of nine (67%) carcinomas showed foamy/pseudohyperplastic (N = 3) or atrophic (N = 3) features. Additionally, five biopsy specimens (5/793, 0.6%) with positive AMACR staining that did not meet the criteria for prostatic cancer on the original H&E slides were considered to be atypia. In this study, we found a 1.1% false-negative rate for carcinoma on routine H&E-stained sections. AMACR immunohistochemical staining has shown the ability to improve detection of small focal prostatic carcinoma that could be missed by conventional histological examination.

Computer-aided detection of prostate cancer

Background Prostate cancer is one of the most frequent cancers in men and is a major cause of mortality in developed countries. Detection of prostate carcinoma at an early stage is crucial for successful treatment. Material and methods A method for the analysis of transrectal ultrasound images aimed at computer-aided diagnosis of prostate cancer is tested in this paper. First, two classifiers based on k-nearest neighbors and Hidden Markov models are compared. Second, the diagnostic capacity of our system is tested by means of a set of experiments where humans with varying degrees of experience classified a set of ultrasound images with and without the aid of the computer-aided system. The corpus used in this study was specifically acquired for this purpose. It consists of 4944 ultrasound images corresponding to 303 patients, and is publicly available for non-commercial use upon request. Results The best classification results achieve an area under the receiver operating characteristic curve of 61.6%. However, the diagnostic capacity of an expert urologist using the computer-aided system improves only slightly compared with his/her capacity without the aid of the system. Conclusions Despite the difficulty of this task, the obtained results indicate that discrimination between cancerous and non-cancerous tissue is possible to a certain degree. The computer-aided system helps an inexperienced user to make a better diagnosis, however it must be able to perform better in order to be useful in a real-world clinical context.

A population‐based survey of prostate‐specific antigen testing among California men at higher risk for prostate carcinoma

Despite the lack of evidence demonstrating a survival benefit from prostate-specific antigen (PSA) screening, its use has become widespread, organizations have encouraged physicians to discuss early detection of prostate carcinoma, and two higher risk groups have been recognized. In the current study, the authors examined whether African-American men and men who had a family history of prostate carcinoma underwent PSA testing preferentially, and patterns of test use were examined according to age, race, and other factors. Data regarding self-reported PSA test use in the past year among men age 50 years and older without a history of prostate carcinoma (n = 8713 men) were analyzed from the 2001 California Health Interview Survey. The overall rate of PSA use was 43.0%. Older age, higher socioeconomic status, having a usual source of healthcare, and a family history of prostate carcinoma were the strongest predictors of testing. Higher risk African-American men age 50 years and older were no more likely to be tested than white men. Men at higher risk who had a family history of prostate carcinoma were more likely to have been tested than men who had no such family history. Rates of PSA use among higher risk men who had a family history of prostate carcinoma were higher compared with the rates among men without such a family history. However, PSA testing rates among higher risk African-American men were no different than the rates among lower risk white men, suggesting that some risk factors for prostate carcinoma (but not others) are associated with preferential testing. Testing in all groups was associated with access to care variables, highlighting the importance of removing barriers to preventive healthcare services.

Using an AMACR (P504S)/34βE12/p63 Cocktail for the Detection of Small Focal Prostate Carcinoma in Needle Biopsy Specimens

Using an AMACR (P504S)/34βE12/p63 Cocktail for the Detection of Small Focal Prostate Carcinoma in Needle Biopsy Specimens

Ratio of prostate specific antigen minor molecular forms-to-total prostate specific antigen is constant regardless of the pathological condition of the prostate.

We assessed 3 molecular forms of prostate specific antigen (PSA) prospectively to determine the real proportion of the nonfree, nonalpha1-antichymotrypsin complex form of PSA-to-total PSA and evaluated the clinical significance of its various forms. We prospectively assessed 1,878 serum samples from 994 subjects for total PSA, free PSA and PSA-alpha1-antichymotrypsin complex (ACT). Nonfree, nonPSA-ACT PSA (minor form PSA) was calculated as the difference between total PSA and the sum of free PSA plus PSA-ACT complex. The proportion of the minor form PSA was approximately 20% to 25% of total PSA at any range of total PSA, whereas that of free PSA and PSA-ACT decreased and increased, respectively, in correlation with the increment of total PSA. There was no significant difference in the percent of minor form PSA in patients with prostatic carcinoma and those with benign prostatic status. The proportion of minor form PSA was constant, while the percent of free PSA and PSA-ACT increased and decreased, respectively, in accordance with total PSA regression after hormonal therapy for prostatic carcinoma. PSA-ACT was judged to be superior to total PSA for distinguishing prostatic carcinoma in men with PSA 2 to 10 ng./ml. by ROC analysis. Approximately a fourth of total PSA consists of minor forms of complexed PSA. The average proportion of minor form-to-total PSA was constant at various levels of total PSA and at any prostatic status of patients. PSA-ACT was superior to total PSA for the early detection of prostatic carcinoma.

Extended peripheral zone biopsy schemes increase cancer detection rates and minimize variance in prostate specific antigen and age related cancer rates: results of a community multi-practice study.

We assessed the impact of age and prostate specific antigen (PSA) on extended systematic biopsy schemes for detecting prostate carcinoma and better characterized these tumors as a function of patient age and PSA. We retrospectively reviewed the records of 2,299 consecutive patients who underwent initial systematic biopsy performed by 167 community based urologists. A total of 12 systematic biopsies of the peripheral zone were obtained in all patients. Various biopsy schemes were then created and cancer detection rates were calculated. Data analyses were stratified by patient age and PSA. On biopsy 1,020 patients (44.4%) had cancer. Detection rates increased with increasing patient age. Increasing age and PSA were associated with larger, higher grade tumors. Overall and unique site specific cancer detection rates were highest for laterally directed biopsies and the apical biopsy of the standard sextant scheme. The 12 site biopsy scheme outperformed all other schemes in patients with PSA 7 ng./ml. or less and in those 60 years or younger. The variation in age related and PSA related detection rates was greatest for the standard sextant scheme and this variability decreased for extended biopsy schemes. This multi-practice community based study confirms the inadequacy of sextant biopsies and emphasizes the need for extended peripheral zone sampling of the lateral aspect of the prostate. Generally increasing patient age and PSA were associated with larger, higher grade tumors. Extended biopsy schemes minimize PSA and age related detection rates.

Detection of prostate carcinoma with contrast‐enhanced sonography using intermittent harmonic imaging

The purpose of this study was to assess prostate carcinoma detection and discrimination of benign from malignant prostate tissue with contrast-enhanced ultrasonography. In all, 301 subjects referred for prostate biopsy were evaluated with contrast-enhanced sonography using continuous harmonic imaging (CHI) and intermittent harmonic imaging (IHI) with interscan delay times of 0.2, 0.5, 1.0, 2.0 seconds, as well as continuous color and power Doppler. Targeted biopsy cores were obtained from sites of greatest enhancement, followed by spatially distributed cores in a modified sextant distribution. Carcinoma was detected in 363 biopsy cores from 104 of 301 subjects (35%). Carcinoma was found in 15.5% (175 of 1133) of targeted cores and 10.4% (188 of 1806) of sextant cores (P < 0.01). Among subjects with carcinoma, targeted cores were twice as likely to be positive (odds ratio [OR] = 2.0, P < 0.001). Clustered receiver operating characteristic (ROC) analysis of imaging findings at sextant biopsy sites yielded the following Az values: precontrast gray scale: 0.58; precontrast color Doppler: 0.53; precontrast power Doppler: 0.58; CHI: 0.62; IHI (0.2 sec): 0.64; IHI (0.5 sec): 0.63; IHI (1.0 sec): 0.65; IHI (2.0 sec): 0.61; contrast-enhanced color Doppler: 0.60; contrast-enhanced power Doppler: 0.62. A statistically significant benefit was found for IHI over baseline imaging (P < 0.05). The carcinoma detection rate of contrast-enhanced targeted cores is significantly higher when compared with sextant cores. Contrast-enhanced transrectal sonography with IHI provides a statistically significant improvement in discrimination between benign and malignant biopsy sites. However, given the relatively low ROC areas, this technique may not be sufficient to predict which patients have benign versus malignant disease.