A prospective randomized trial comparing contrast-enhanced targeted versus systematic ultrasound guided biopsies: impact on prostate cancer detection.
BACKGROUND
We performed a prospective randomized trial comparing 5 contrast-enhanced color Doppler (CECD) ultrasound (US) targeted biopsy cores to 10 gray-scale US guided systematic biopsy (SB) cores to determine the impact on the cancer detection rate.


METHODS
We prospectively randomized 100 prostate specific antigen (PSA) screening volunteers with an elevated PSA (> or =1.25 ng/ml and free-to-total PSA < 18%) to undergo contrast-enhanced targeted or SB. Contrast-enhanced targeted biopsies with a limited number of five cores were performed into hypervascular areas of the peripheral zone (PZ) during administration of the US contrast agent SonoVue (Bracco, Italy). A subjective grading of the vascularity from 0 to 3 was used: grade 0, no color signal; 1, low density; 2, medium density; and 3, high density of color signals. Ten SBs were obtained in a standard spatial distribution. Cancer detection rates were compared in the groups.


RESULTS
Cancer was detected in 16/50 subjects (32%) by targeted biopsy, and in 13/50 patients (26%) with SB. The cancer detection rate was significantly better for the targeted approach (P < 0.04, McNemar). The detection rate for targeted biopsy cores (15.6% or 39/250 cores) was significantly better than for SB cores (6.8% or 34/500 cores, P < 0.001, McNemar).


CONCLUSIONS
CECD targeted biopsy detected more cancers than SB with a reduced number of biopsy cores.
Mitterberger
Michael
M
Department of Urology, Medical University Innsbruck, Innsbruck, Austria. michael.mitterberger@uibk.ac.at
Horninger
Wolfgang
W
Pelzer
Alexandre
A
Strasser
Hannes
H
Bartsch
Georg
G
Moser
Patrizia
P
Halpern
Ethan J
EJ
Gradl
Johann
J
Aigner
Friedrich
F
Pallwein
Leo
L
Frauscher
Ferdinand
F
D000230:Adenocarcinoma / Q000097:blood / Q000000981:diagnostic imaging* / Q000601:surgery; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000601:surgery; D018615:Ultrasonography, Doppler, Color
D017430:Prostate-Specific Antigen