CE-TRUS-targeted vs. systematic, TRUS-guided biopsy of the prostate to diagnose prostate cancer

Contrast-enhanced, transrectal ultrasound (CE-TRUS) technology has been found to better detect high-grade prostate cancer than conventional forms of TRUS, which may make it a more appropriate method for the diagnosis of clinically important cancers and monitoring low-risk ones with less biopsies.

Detailed data on a Phase III trial of this technology is available in a media release from Thomas Jefferson University and Hospitals and in the abstract of a study by Halpern et al., published online in September in the Journal of Urology.

Halpern et al. set out to investigate (a) whether targeted CE-TRUS-guided biopsies were more accurate than standard TRUS-guided “systematic” 12-core biopsies and (b) whether the additional use of short-term treatment with dutasteride, prior to biopsy had any impact on prostate cancer detection.

The study was structured as a randomized, double-blind, placebo-controlled trial of oral dutasteride pretreatment. Initial CE-TRUS findings were graded and were then used to direct targeted biopsies (of up to six cores per prostate). An additional, blinded, 12-core, systematic biopsy was then performed on every subject, based on standard medial and lateral sampling of each sextant. In other words, every patient received two biopsies, one targeted and the other systematic, but the systematic biopsies were carried out by different investigators to the targeted biopsies so as to avoid any risk for bias.

Here are the study findings:

  • 311 men were randomized to dutasteride or a placebo.
  • 272 men completed trial participation.
  • 203/1,237 CE-TRUS-targeted biopsy cores (16.4 percent) were positive for prostate cancer.
  • 276/3,264 systematic, TRUS-guided biopsy cores (8.5 percent) were positive for prostate cancer.
  • There was a significant improvement in accuracy of CE-TRUS-based imaging compared to standard TRUS imaging (p = 0.0005).
  • In the case of men with high-grade prostate cancer (where > 50 percent of the biopsy cores were positive for cancer), CE-TRUS-based imaging was again superior to standard TRUS-based imaging (p = 0.001).
  • Pretreatment with dutasteride had no significant impact on the detection of prostate cancer (p = 0.97).

Halpern et al. conclude that CE-TRUS-targeted prostate biopsies offer a significant benefit compared to standard, TRUS-guided, systematic 12-core biopsies for the detection of high grade/high volume prostate cancer. What we still do not know, however, is whether color-enhanced Doppler TRUS-guided biopsies are any more accurate than standard, TRUS-guided, systematic 12-core biopsies for the detection of prostate cancer.

2 Responses

  1. I am not sure the last sentence is consistent with research findings as listed in PubMed.

  2. Although not a previous believer of the value of contrast-enhanced US, this study is well done and may help shift the curve somewhat of those against screening by enabling men with low volume, low grade cancer to avoid a cancer diagnosis while more often finding those with potentially dangerous disease. At the same time, it might reduce the infection rate by both lowering the number of cores obtained or avoiding them entirely. In addition, it could help do away with saturation biopsies. Lastly, it could reduce cost.

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