Does the adjunct of ecographic contrast medium Levovist® improve the detection rate of prostate cancer?

Abstract

Objectives: To evaluate whether the adjunct of an ultrasound contrast medium improves the detection rate of prostate cancer. Method: In 34 patients, scheduled to undergo a trans-perineal extended prostate biopsy, we carried out a color-Doppler ultrasound (CDU) of the prostate before and after i.v. injection of Levovist s , an ultrasound contrast medium. Further bioptic samples were taken in the areas where a marked increase in vascularization was noticed. Results: The overall diagnostic sensitivity, specificity and efficiency were respectively 72.7, 56.2 and 62.9% for transrectal ultrasound (TRUS); 80, 56.2 and 65.3% for CDU and 88.8, 54.5 and 68% for CDU after Levovist s injection; 66.5, 72.6 and 65.1% for digito-rectal examination (DRE); 100, 51.4 and 65.4% for total PSA; and 100, 88.8 and 94.3% for PSA free/total. In the 16 patients with prostate carcinoma, the sensitivity of CDU after Levovist s was 92.3, 66% for both DRE and TRUS, and 80% for DRE plus TRUS. Conclusions: Considering the cost and the results obtained (high sensitivity and low specificity), a routine use of Levovist s does not seem indicated in patients undergoing prostatic biopsy. An exception may be represented by patients with both negative DRE and TRUS.

Prostate Needle Biopsy: 12 vs. 18 Cores – Is It Necessary?

“…Djavan et al [8] report a PCa incidence after the second, third, and fourth sextant biopsies in patients with a negative DRE and a PSA included between 4 and 10 ng/ml equal to 10, 5 and 4%, respectively. On the other hand, actual imaging means are not provided with suitable sensibility and specificity for the implementation of cores aimed in suspected zones; even if some authors suggest using the echographic contrast medium to increase the ultrasound diagnostic efficiency, at present there are conflicting results in literature [9,10]. Therefore, the adoption of extended TRUS-guided prostatic needle biopsy schemes with an increased number of cores on the peripheral portion and on the lateral margins of the gland constitutes, nowadays, the only suitable method to increase the PCa diagnosis considering; moreover, the homogenous incidence of neoplasia on the peripheral portion of the prostatic gland [11].…”

Accuracy of 3 Tesla pelvic phased-array multiparametric MRI in diagnosing prostate cancer at repeat biopsy

“…Although TRUS imaging was enriched in recent years by the introduction of three-dimensional, computerized images and contrast media, which allow better characterization of intraparenchymal microvasculature (21), ultrasound accuracy is poor in performing targeted-biopsy (22,23); therefore, SPBx still today remains the gold standard (2,18) in case of repeat prostate biopsy. On the other hand, transrectal prostate biopsy, recently, has been associated with an increased risk of complications secondary to urinary tract infection and sepsis (1% of the cases), with the necessity for hospital admission in 2% of the cases (24); conversely, transperineal prostate biopsy demonstrated a better accuracy in comparison with transrectal approach in the diagnosis of anterior zone PCa (15,25), resetting the risk of sepsis (26,27).…”

Methods for volume assessment of prostate cancer

“…The sensitivity of three-dimensional power Doppler imaging for the detection of prostate malignancy increases from 38 to 85% by means of contrast enhancement [40]. However, despite these promising results, contrast-enhanced Doppler ultrasound could not gain popularity due to its costs and low specificity rate [41].…”