Color Doppler ultrasound in the biopsy-based diagnosis of prostate cancer

A new report from an Italian clinical research team, and based on a randomized clinical trial of 300 patients, suggests that color Doppler ultrasound offers no significant benefit over standard “gray-scale” ultrasound in the biopsy-based diagnosis of prostate cancer — which is not going to please the advocates of color Doppler ultrasonography.

Since the late 1980s it has been customary to use transrectal gray-scale ultrasonography (gray-scale TRUS) as the standard method to guide needle placement in the biopsy sampling of prostate tissue when attempting to diagnose localized prostate cancer in men with a suspicious PSA level or and abnormal digital rectal examination (DRE) result. However, it is generally agreed that some 10 to 30 percent of cancers may remain undiagnosed after a single gray-scale TRUS-guided biopsy (regardless of the precise number of standard biopsy cores removed the strategy applied).

Taverna et al. set out to compare the rate of prostate cancer detection using a randomized clinical trial process in which patients were randomized to one of three groups based on their TRUS-guided biopsy strategies:

  • Standard biopsy under gray-scale TRUS guidance (Group A)
  • Biopsy under color Doppler TRUS guidance (Group B)
  • Biopsy under color Doppler TRUS guidance with the injection of the SonoVue™ microbubble contrast agent (Group C)

The trial enrolled patients who had PSA values between 2.5 and 9.9 ng/ml, negative digital rectal examination (DRE) results, and no visible evidence of cancer on grey-scale TRUS. The patients were then randomly assigned to one of the three above groups, with 100 patients in each of the three groups.

Contrast-enhanced biopsies samples were taken from the peripheral, transitional, apical or anterior prostate zones of all 300 patients. The patients in Groups B and C underwent a further 13 systematic prostate biopsies.

The base findings were as follows:

  • 88/300 patients (29.3 percent) had a positive histological diagnosis of prostate cancer.
  • 22/300 patients (7.4 percent) had a histological diagnosis of high-grade prostatic intraepithelial neoplasia (HG-PIN) or atypical small acinar proliferation (ASAP). •
  • There were no significant differences in the rates of detection of prostate cancer among the three patient groups (P = 0.329)
  • Color Doppler ultrasound was found to have low sensitivity, low specificity, and low accuracy with or without the addition of the SonoVue contrast agent.

Taverna et al. conclude (among other things) that the prostate cancer detection rate is not significantly improved by the use of color Doppler TRUS guidance with or without the SonoVue contrast agent as compared to standard gray-scale TRUS guidance.

4 Responses

  1. Is there any discussion as to the experience of the color Doppler operator and their experience interpreting the results? In the hands of the right technician (e.g., Duke Bahn or Katsuto Shinohara in California), I am aware of anecdotal cases where Doppler produced very significant results not discovered by gray scale TRUS.

    I doubt a color Doppler machine placed in the hands of a urologist who has largely used gray scale, would produce better results.


  2. I can already hear the naysayers. This isn’t the first such study I recall seeing on this here at the InfoLink. I think a study in Germany showed a 15% failure to detect rate that TRUS biopsies found cancer in. Of course, the counter-argument will be that there is no doctor in Italy like the some well-talked about CDU super-heroes here stateside …

    But I’ll bite. It’s time for a comparative study here from Ventura and Rochester … I’m sure there is a role for CDU in prostate cancer biopsies ~ but right now I’m not swayed …

  3. Very confusing when you read conflicting reports … See, for example this one, which says that

    “According to a recent article published in The Journal of Urology, the use of contrast enhanced color Doppler in endorectal ultrasound improves the detection of prostate cancer.”

    Why the difference? Who do you believe these days?

  4. I think the answer to your question is actually rather straightforward … There is no consensus about the value of some types of technology … Different researchers can and do get different results … As a consequence, the learning for patients is that you shouldn’t take everything you are told as being “the truth.” The Devil is usually in the details of how these different studies are carried out.

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