title: Comparison of contrast enhanced color Doppler targeted biopsy to conventional systematic biopsy: impact on Gleason score.
abstract: OBJECTIVE
  Prostate cancer grading with Gleason score is an important prognostic factor. This prospective randomized study compares ultrasound systematic biopsy vs contrast enhanced color Doppler targeted biopsy for the impact on Gleason score findings.
  
  
  METHODS
  We examined 690 men (mean age 56 years, range 41 to 77) with a serum total prostate specific antigen of 1.25 ng/ml or greater, a free-to-total prostate specific antigen ratio less than 18% and/or a suspicious digital rectal examination. Contrast enhanced color Doppler targeted biopsies with a limited number of cores (5 or less) were performed in hypervascular areas of the peripheral zone during administration of the ultrasound contrast agent Sonovuetrade mark (Bracco, Milano, Italy). Ten systematic biopsies were obtained in a standard spatial distribution. Cancer detection rates and Gleason score were compared.
  
  
  RESULTS
  Prostate cancer was identified in 221 of 690 subjects (32%) with a mean prostate specific antigen of 4.6 ng/ml (range 1.4 to 35.0). Prostate cancer was detected in 180 of 690 subjects (26%) with contrast enhanced color Doppler targeted biopsy and in 166 of 690 patients (24%) with systematic ultrasound biopsy. The Gleason score of all 180 cancers detected on contrast enhanced color Doppler targeted biopsy was 6 or higher (mean 6.8). The Gleason score of all 166 cancers detected on systematic biopsy ranged from 4 to 6 and mean Gleason score was 5.4. Contrast enhanced color Doppler targeted biopsy detected significantly higher Gleason scores compared to systematic biopsy (Wilcoxon rank sum test p <0.003).
  
  
  CONCLUSIONS
  Contrast enhanced color Doppler targeted biopsy detected cancers with higher Gleason scores and more cancer than systematic biopsy. Therefore, contrast enhanced color Doppler seems to be helpful in the grading of prostate cancer, which is important for defining prognosis and deciding treatment.
authors.affiliation: Departments of Urology and Radiology 2, Medical University Innsbruck, Innsbruck, Austria. mitterberger@uibk.ac.at
authors.forename: M
authors.initials: M
authors.lastname: Mitterberger
authors.forename: G M
authors.initials: GM
authors.lastname: Pinggera
authors.forename: W
authors.initials: W
authors.lastname: Horninger
authors.forename: G
authors.initials: G
authors.lastname: Bartsch
authors.forename: H
authors.initials: H
authors.lastname: Strasser
authors.forename: G
authors.initials: G
authors.lastname: Schäfer
authors.forename: A
authors.initials: A
authors.lastname: Brunner
authors.forename: Ethan J
authors.initials: EJ
authors.lastname: Halpern
authors.forename: J
authors.initials: J
authors.lastname: Gradl
authors.forename: L
authors.initials: L
authors.lastname: Pallwein
authors.forename: F
authors.initials: F
authors.lastname: Frauscher
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D003287:Contrast Media; D019160:Endosonography; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D019048:Prostatic Intraepithelial Neoplasia / Q000473:pathology; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D018615:Ultrasonography, Doppler, Color
chemical_list: D003287:Contrast Media; D017430:Prostate-Specific Antigen