Dutasteride prior to contrast-enhanced colour Doppler ultrasound prostate biopsy increases prostate cancer detection.
OBJECTIVE
This study assessed the effect of premedication with dutasteride, a dual 5alpha-reductase inhibitor, on prostatic blood flow prior to prostate biopsy and its impact on prostate cancer detection.


METHODS
Thirty-six patients, aged 52-74 yr, with elevated prostate-specific antigen (PSA) levels (>or=1.25 ng/ml and free-to-total ratio of <18%) were treated with dutasteride 14 d prior to prostate biopsy. Contrast-enhanced colour Doppler (CECD) ultrasound was performed before and 7 and 14 d after dutasteride treatment. Contrast-enhanced targeted biopsies (<or=5) were performed into hypervascular areas of the peripheral zone only. Subsequently, a second investigator performed 10 systematic biopsies of the prostate in a standard spatial distribution guided by conventional grey-scale ultrasonography on a Combison 530MT unit.


RESULTS
Dutasteride reduced prostatic blood flow in benign prostatic tissue, whereas in prostate cancer areas blood flow was still observed after a 14-d course of dutasteride intake. A reduction of blood flow was observed even after 7 d. Maximum flow reduction was observed after 14 d. Twelve patients (33%) of our cohort were found to have suspicious blood flow and prostate cancer and six cancers (17%) were detected solely by targeted contrast-enhanced biopsy.


CONCLUSIONS
Premedication with dutasteride seems promising to improve prostate cancer detection by using CECD ultrasound.
Mitterberger
Michael
M
Department of Urology, Medical University Innsbruck, Innsbruck, Austria. michael.mitterberger@uibk.ac.at
Pinggera
Germar
G
Horninger
Wolfgang
W
Strasser
Hannes
H
Halpern
Ethan
E
Pallwein
Leo
L
Gradl
Johann
J
Bartsch
Georg
G
Frauscher
Ferdinand
F
D013741:3-Oxo-5-alpha-Steroid 4-Dehydrogenase; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D001378:Azasteroids / Q000008:administration & dosage*; D001706:Biopsy / Q000379:methods*; D001783:Blood Flow Velocity / Q000187:drug effects*; D003287:Contrast Media; D000068538:Dutasteride; D019160:Endosonography; D004791:Enzyme Inhibitors / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D011467:Prostate / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000188:drug therapy; D015203:Reproducibility of Results; D018615:Ultrasonography, Doppler, Color / Q000379:methods*
D001378:Azasteroids; D003287:Contrast Media; D004791:Enzyme Inhibitors; D013741:3-Oxo-5-alpha-Steroid 4-Dehydrogenase; D000068538:Dutasteride