Contrast-enhanced transrectal ultrasound can reduce unnecessary biopsy during prostate cancer screening and predict biochemical recurrence after radical prostatectomy in patients with localized prostate cancer

Abstract

Background: To investigate the value of contrast-enhanced transrectal ultrasound (CETRUS) in reducing unnecessary biopsy during prostate cancer screening and predicting biochemical recurrence in patients with localized prostate cancer. Methods:This was a prospective study of patients suspected of prostate cancer who were evaluated with CETRUS followed by prostate biopsy. Prostate blood flow on CETRUS was graded using a 5-point scale. The relationship between CETRUS score and biopsy outcomes was analyzed; Univariate and multi-variate analyses were used to determine the probable prognostic factors with biochemical recurrence in patients with localized prostate cancer underwent radical prostatectomy. Results:A total of 347 patients were enrolled. Prostate cancer was found in 164 patients. A significant positive correlation (r = 0.69, p < 0.001) was found between CETRUS scores and prostate cancer. Using CETRUS score ≥ 2 as the threshold for biopsy could have reduced the number of biopsies by 12.1% (42/347) without missing cancer and spared 23.0% (42/183) of patients from unnecessary biopsy. 77 patients with localized prostate cancer underwent radical prostatectomy and followed up. 17 of 77 patients exhibited biochemical recurrence. The 3-year biochemical recurrence-free survival rates were 86% for patients with CETRUS low scores (≤ 3) and 59% for patients with high scores (> 3; p = 0.015). Multivariate Cox regression analysis showed that CETRUS score was an independent predictor of biochemical recurrence (HR: 7.02; 95% CI: 2.00-24.69; p = 0.002). Conclusions:CETRUS score may be a useful tool to reduce unnecessary biopsy during prostate cancer screening and predict biochemical recurrence of localized prostate cancer after radical prostatectomy. BackgroundProstate cancer is the most common solid neoplasm and the second leading cause of cancer death in men in the U.S. [1]. With increasing incidence and mortality, an estimated 60,300 new cases were diagnosed and 26,600 deaths were attributed to this disease in China in 2015 [2]. Approximately one million prostate biopsies are conducted per year in the U.S.. However, prostate-specific antigen (PSA) testing, the most widely used screening tests for prostate cancer, leads to 750,000 unnecessary biopsies-and attendant pain, inconvenience, financial burden, and risk of infection [3]. Therefore, Hong-wei Zhao and Yong Fang: Project development, Data Collection, Study design, Manuscript editing; Jian Li, Jia-Zheng Cao and Juan Lin: Manuscript writing, Study design, Data Collection, Statistical analysis; Zhu Wang, Jian-yao Lv,and Jin-huan We:Manuscript editing, Data Collection; Jinhuan Wei and Zhen-hua Chen: Data Collection,Statistical analysis; Hao-hua Yao, Yi-hui Pan, Zhen-li Gao, Jun-hang Luo, Wei Chen,and Lei Shi: Data Collection, Datainterpretation. All authors read and approved the final manuscript.