PURPOSE: The identification of clinically significant disease is crucial for optimal treatment of prostate cancer. Selective detection of prostate cancer with increased microvessel density is possible with contrast enhanced ultrasound. Preliminary studies suggest that pretreatment with a 5α-reductase inhibitor may improve the efficiency of contrast enhanced ultrasound targeted biopsy. This study was designed to quantify prostate cancer detection with contrast enhanced ultrasound with or without short-term pretreatment with dutasteride. MATERIALS AND METHODS: In this randomized, double-blind, placebo controlled trial of oral dutasteride pretreatment, contrast enhanced ultrasound findings were graded and used to direct targeted biopsy (up to 6 cores per prostate). A blinded 12-core systematic biopsy was subsequently performed on every subject based on standard medial and lateral sampling of each sextant. RESULTS: Of 311 subjects who underwent randomization, 272 completed participation. Positive biopsies were obtained in 276 of 3,264 (8.5%) systematic cores and 203 of 1,237 (16.4%) targeted cores (OR 2.1, 95% CI 1.7-2.6, p <0.001). ROC analysis for the detection of all prostate cancers demonstrated an increase in diagnostic accuracy from pre-contrast imaging to contrast enhanced ultrasound (A(z) 0.60 vs 0.64, p = 0.005). For the detection of high grade cancer (Gleason score 7 or greater) ROC analysis demonstrated improved accuracy for pre-contrast imaging (A(z) 0.74) and contrast enhanced ultrasound (A(z) 0.80, p = 0.0005). For the detection of high grade cancer with greater than 50% biopsy core involvement, excellent accuracy was demonstrated with pre-contrast and contrast enhanced ultrasound, A(z) 0.83 and 0.90, respectively (p = 0.001). Pretreatment with dutasteride had no significant impact on the detection of prostate cancer (p = 0.97). CONCLUSIONS:Contrast enhanced ultrasound targeted biopsy provides a significant benefit for the detection of high grade/high volume prostate cancer.
RCT Entities:
PURPOSE: The identification of clinically significant disease is crucial for optimal treatment of prostate cancer. Selective detection of prostate cancer with increased microvessel density is possible with contrast enhanced ultrasound. Preliminary studies suggest that pretreatment with a 5α-reductase inhibitor may improve the efficiency of contrast enhanced ultrasound targeted biopsy. This study was designed to quantify prostate cancer detection with contrast enhanced ultrasound with or without short-term pretreatment with dutasteride. MATERIALS AND METHODS: In this randomized, double-blind, placebo controlled trial of oral dutasteride pretreatment, contrast enhanced ultrasound findings were graded and used to direct targeted biopsy (up to 6 cores per prostate). A blinded 12-core systematic biopsy was subsequently performed on every subject based on standard medial and lateral sampling of each sextant. RESULTS: Of 311 subjects who underwent randomization, 272 completed participation. Positive biopsies were obtained in 276 of 3,264 (8.5%) systematic cores and 203 of 1,237 (16.4%) targeted cores (OR 2.1, 95% CI 1.7-2.6, p <0.001). ROC analysis for the detection of all prostate cancers demonstrated an increase in diagnostic accuracy from pre-contrast imaging to contrast enhanced ultrasound (A(z) 0.60 vs 0.64, p = 0.005). For the detection of high grade cancer (Gleason score 7 or greater) ROC analysis demonstrated improved accuracy for pre-contrast imaging (A(z) 0.74) and contrast enhanced ultrasound (A(z) 0.80, p = 0.0005). For the detection of high grade cancer with greater than 50% biopsy core involvement, excellent accuracy was demonstrated with pre-contrast and contrast enhanced ultrasound, A(z) 0.83 and 0.90, respectively (p = 0.001). Pretreatment with dutasteride had no significant impact on the detection of prostate cancer (p = 0.97). CONCLUSIONS: Contrast enhanced ultrasound targeted biopsy provides a significant benefit for the detection of high grade/high volume prostate cancer.
Authors: Michael Mitterberger; Friedrich Aigner; Germar M Pinggera; Eberhard Steiner; Peter Rehder; Hanno Ulmer; Ethan J Halpern; Wolfgang Horninger; Ferdinand Frauscher Journal: BJU Int Date: 2010-11 Impact factor: 5.588
Authors: Michael Josef Mitterberger; Friedrich Aigner; Wolfgang Horninger; Hanno Ulmer; Silvio Cavuto; Ethan J Halpern; Ferdinand Frauscher Journal: Eur Radiol Date: 2010-06-23 Impact factor: 5.315
Authors: H A Bogers; J P Sedelaar; H P Beerlage; J J de la Rosette; F M Debruyne; H Wijkstra; R G Aarnink Journal: Urology Date: 1999-07 Impact factor: 2.649
Authors: Michael Mitterberger; Wolfgang Horninger; Friedrich Aigner; Germar M Pinggera; Peter Rehder; Eberhard Steiner; Christian Wiunig; Andreas Reissigl; Ferdinand Frauscher Journal: BJU Int Date: 2009-10-26 Impact factor: 5.588
Authors: Robert A Linden; Edouard J Trabulsi; Flemming Forsberg; Paul R Gittens; Leonard G Gomella; Ethan J Halpern Journal: J Urol Date: 2007-10-22 Impact factor: 7.450
Authors: Ashwin N Sridhar; Archie Hughes-Hallett; Erik K Mayer; Philip J Pratt; Philip J Edwards; Guang-Zhong Yang; Ara W Darzi; Justin A Vale Journal: Nat Rev Urol Date: 2013-06-18 Impact factor: 14.432
Authors: Hong Truong; Jennifer Logan; Baris Turkbey; M Minhaj Siddiqui; Soroush Rais-Bahrami; Anthony N Hoang; Chad Pusateri; Brian Shuch; Annerleim Walton-Diaz; Srinivas Vourganti; Jeffrey Nix; Lambros Stamatakis; Colette Harris; Celene Chua; Peter L Choyke; Bradford J Wood; Peter A Pinto Journal: Can J Urol Date: 2013-12 Impact factor: 1.344
Authors: Jean-Michel Correas; Ethan J Halpern; Richard G Barr; Sangeet Ghai; Jochen Walz; Sylvain Bodard; Charles Dariane; Jean de la Rosette Journal: World J Urol Date: 2020-04-18 Impact factor: 4.226