Contrast-Enhanced Sonography for Prostate Cancer Detection in Patients with Indeterminate Clinical Findings

Abstract

G e n i t o u r i n a r y I m a g i n g • O r i g i n a l R e s e a r c h Contrast-EnhancedOBJECTIVE. The purpose of our study was to evaluate the usefulness of contrast-enhanced sonography for prostate cancer detection in patients with an indeterminate prostate-specific antigen (PSA) level (4-10 ng/mL) and negative findings on digital rectal examination.SUBJECTS AND METHODS. Forty-eight patients underwent gray-scale, color Doppler, and contrast-enhanced sonography examinations and then sonographically guided biopsy. Contrast-enhanced sonography was performed using Levovist at a mechanical index of 1.1-1.4. The performances of the three methods for cancer detection were compared according to biopsy site and patient.RESULTS. Sensitivity by biopsy site was greater on contrast-enhanced sonography (68%) than on gray-scale (39%) and color Doppler (41%) sonography (p ≤ 0.05), whereas the specificity and overall accuracy by biopsy site (82% and 77% for gray-scale sonography, 84% and 79% for color Doppler sonography, and 83% and 81% for contrast-enhanced sonography, respectively) were not different for the three methods (p > 0.05). The concordance score for sonography and biopsy results by patient was not different for gray-scale (6.4 ± 1.8), color Doppler (6.3 ± 0.6), and contrast-enhanced sonography (6.5 ± 0.7) (p = 0.281).CONCLUSION. Contrast-enhanced sonography could improve only the sensitivity for cancer detection in analysis by biopsy site but did not improve the overall performance of sonography in patients with an indeterminate PSA level and negative digital rectal examination. rostate cancer is a common malignant neoplasm in men. Its incidence has been increasing because of improvements in diagnostic testing, increasing life expectancy, and the presence of environmental carcinogens [1,2]. Although sonography has wisely been used for evaluating the prostate, many reports have shown the limitations of sonography for cancer detection based on its unsatisfactory sensitivity and variable accuracy [3][4][5][6][7][8].Over the past few years, microbubble contrast-enhanced sonography has been introduced as a promising tool that can improve prostate cancer detection. Halpern et al. [1], in an early large study, showed significant improvement of the sensitivity from 38% on gray-scale and color or power Doppler sonography to 65% with contrast-enhanced (CE) sonography. Thereafter, several studies also reported an increased sensitivity of up to 86% [9][10][11][12]. However, the actual merit of sonographic contrast material may be in question because the performance of CE sonography varied in those studies. The variable degree of cancer risk in the study populations of previous studies may be largely responsible for the variable results of those studies; patients with a high PSA level and positive digital rectal examination may have a greater chance of having positive sonographic findings than those with an indeterminate risk of prostate cancer [9][10][11][12][13][14]. Therefore, if CE sonography were shown to have improved ...

Imaging in Prostate Cancer Diagnosis: Present Role and Future Perspectives

“…Nevertheless, targe ted biopsies missed 20% of cancers, which were detected on systematic biopsy alone, leading to the conclusion that systematic biopsy could not be omitted from a biopsy scheme [24] . The study by Yi et al [25] demonstrated that the sensitivity on biopsy site was greater on contrast-enhanced sonography (68%) than on gray-scale (39%) and color Doppler (41%) sonography. Moreover, Drudi et al [26] demonstrated that contrastenhanced sonography may also be used in the diagnosis of local recurrence after radical prostatectomy in patients with increasing PSA.…”

Influence of Serum Prostate-Specific Antigen (PSA) Level, Prostate Volume, and PSA Density on Prostate Cancer Detection With Contrast-Enhanced Sonography Using Contrast-Tuned Imaging Technology

“…2,3 To improve the detection of prostate cancer and limit the number of biopsy cores, the use of ultrasound contrast agents has been advocated by several authors. [4][5][6][7][8][9][10][11] Several studies reported that contrast-enhanced sonography had increased sensitivity of up to 100% in different study populations. [8][9][10][11]18 In an early study, Halpern et al 11 showed significant improvement in the sensitivity from 38% on grayscale and Doppler sonography to 65% on contrastenhanced sonography in 60 patients with PSA levels of greater than 4 ng/mL or PSA velocities of 0.75 ng/mL/y.…”

“…[8][9][10][11]18 In an early study, Halpern et al 11 showed significant improvement in the sensitivity from 38% on grayscale and Doppler sonography to 65% on contrastenhanced sonography in 60 patients with PSA levels of greater than 4 ng/mL or PSA velocities of 0.75 ng/mL/y. In a study by Yi et al, 9 contrast-enhanced sonography was concluded to improve only the sensitivity (68%) but did not improve the overall diagnostic performance in 48 patients with PSA levels of 4 to 10 ng/mL. Recently, Aigner et al 18 reported sensitivity of 100% in 44 men with a mean PSA level of 3.8 ng/mL and contrast-enhanced sonographically positive findings.…”

“…[4][5][6][7] The detection of prostate cancer was significantly improved by the use of contrast-enhanced sonography compared with baseline grayscale and Doppler imaging. [8][9][10][11] The sensitivity of contrast-enhanced sonography in these studies varied between 65% and 93%. [8][9][10][11] Our previous study showed that contrast-enhanced sonography using contrasttuned imaging technology could improve sensitivity to 73.1% compared with baseline imaging (combination of grayscale and power Doppler imaging).…”

“…[8][9][10][11] The sensitivity of contrast-enhanced sonography in these studies varied between 65% and 93%. [8][9][10][11] Our previous study showed that contrast-enhanced sonography using contrasttuned imaging technology could improve sensitivity to 73.1% compared with baseline imaging (combination of grayscale and power Doppler imaging). 12 Numerous factors may account for the variation in these results; the different study populations of those studies may have been largely responsible for it.…”