Ethan J. Halpern MD, Presenter: Research grant, Koninklijke Philips Electronics NV Research grant, Lantheus Medical Imaging, Inc Equipment support, Toshiba Corporation

Joseph R Zola, Abstract Co-Author: Nothing to Disclose

Peter McCue MD, Abstract Co-Author: Nothing to Disclose

Leonard G. Gomella MD, Abstract Co-Author: Consultant, GlaxoSmithKline plc

Flemming Forsberg PhD, Abstract Co-Author: Equipment support, Toshiba Corporation Equipment support, Siemens AG Research collaboration, General Electric Company Research collaboration, Ultrasonix Medical Corporation Research collaboration, Toshiba Corporation

Edouard J. Trabulsi MD, Abstract Co-Author: Nothing to Disclose

To investigate the effectiveness of contrast enhanced transrectal ultrasound (CE-TRUS) and targeted prostate biopsy in comparison with whole-mount radical prostatectomy specimens for the detection and discrimination of prostate cancer.

CE-TRUS with prostate biopsy was performed in 27 subjects using an endfire endocavitary probe. Each TRUS evaluation included conventional gray-scale and Doppler ultrasound at baseline and again during intravenous infusion of a microbubble contrast agent (perflutren lipid microsphere, Definity®, Lantheus Medical Imaging, N Billerica, MA). Areas of enhancement or abnormal vascularity were identified prospectively and localized within the prostate. Targeted biopsy cores were obtained from sites of greatest enhancement, followed by systematic spatially distributed cores consistent with a standard-of-care prostate biopsy. Each patient subsequently underwent radical prostatectomy. CE-US findings and targeted biopsy results were compared with whole-mount prostatectomy specimens.

Ninety foci of prostate cancer were present at pathologic evaluation, with multifocal disease in 25 of 27 glands. Standard grayscale imaging detected 19/90 (21%) of foci, while CE-TRUS demonstrated 65/90 (72%) of lesions with a false negative rate of 28%. Evaluated per patient, 96% (26 of 27) had suspicious CE-TRUS findings. Systematic biopsy detected 51/90 (57%) foci with an average Gleason score of 6.1. Targeted biopsy demonstrated 37/90 (41%) foci with an average Gleason score of 6.5. Among positive biopsy cores, high-grade carcinoma (Gleason ≥7) comprised 41% (15 of 37) in targeted cores versus 29% (15 of 51) in systematic cores (P=0.05). Targeted biopsy technique discovered 15 distinct foci undetected by systematic biopsy (16% of total foci), but missed 29 foci (32% of total foci) found with the systematic biopsy approach. Combined, targeted plus systematic biopsy detected 73% (66 of 90) of foci.

Contrast-enhanced ultrasonography visualizes more neoplastic lesions than grayscale imaging alone, and tends to identify higher grade cancers.  Targeted biopsy of the prostate based upon CE-TRUS discriminates higher grade cancers and elucidates additional cancer foci undetected by systematic biopsy.

Targeted biopsy of the prostate based upon CE-TRUS can improve the detection of higher grade, clinically relevant, prostate cancer.

Halpern, E, Zola, J, McCue, P, Gomella, L, Forsberg, F, Trabulsi, E, Comparison of Contrast-enhanced Ultrasound and Targeted Biopsy of the Prostate to Whole Mount Radical Prostatectomy Specimens for Detection of Prostate Cancer.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9001198.html