title: Contrast-enhanced transrectal ultrasound (CE-TRUS) with cadence-contrast pulse sequence (CPS) technology for the identification of prostate cancer.
abstract: OBJECTIVE
  Various imaging modalities, such as magnetic resonance imaging (MRI), have been assessed with regard to their value in the detection of prostate cancer (CaP). However, there is a need for less time-consuming and more cost effective procedures in urology. In order to determine the ability of contrast-enhanced transrectal ultrasound (CE-TRUS) to identify CaP, we investigated patients scheduled for radical prostatectomy for CaP and radical cystoprostatectomy for bladder cancer.
  
  
  METHODS
  Between May and August 2008, 35 consecutive patients with CaP and muscle-invasive bladder carcinoma were prospectively enrolled in this single center study. All patients underwent B-mode TRUS and CE-TRUS (Sequoia 512 unit with an endocavity probe EV8C4, 8 MHz; Siemens, Erlangen, Germany) by one investigator blinded to any clinical data before radical surgery. Contrast-enhanced images were obtained after intravenous infusion of a bolus (2.4 ml) of the contrast agent SonoVue (Bracco, Milan, Italy). Ultrasound findings (CE-TRUS and B-mode TRUS) were correlated with step-section histology.
  
  
  RESULTS
  On a per-patient basis, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for detecting CaP with CE-TRUS were 71.0%, 50.0%, 91.7%, and 18.2%, respectively. In comparison with B-mode TRUS (sensitivity 45.2%, specificity 75.0%, PPV 93.3%, and NPV 18.0%), CE-TRUS performed significantly better (P=0.004, McNemar test). On a per-prostate-lobe basis sensitivity, specificity, PPV, and NPV were 69.0%, 33.3%, 83.3%, and 18.2%.
  
  
  CONCLUSIONS
  CE-TRUS detected prostate cancer with a modest sensitivity and a high PPV in a selected patient cohort. Future randomized-controlled multicenter studies are needed to further validate the value of CE-TRUS in the detection of CaP. Based on our results, CE-TRUS may not be recommended as a routine procedure in the diagnosis of CaP at present.
authors.affiliation: Department of Urology, Hospital of the University of Munich-Campus Grosshadern, Munich, Germany. michael.seitz.@med.uni-muenchen.de
authors.forename: Michael
authors.initials: M
authors.lastname: Seitz
authors.forename: Christian
authors.initials: C
authors.lastname: Gratzke
authors.forename: Boris
authors.initials: B
authors.lastname: Schlenker
authors.forename: Alexander
authors.initials: A
authors.lastname: Buchner
authors.forename: Alexander
authors.initials: A
authors.lastname: Karl
authors.forename: Alexander
authors.initials: A
authors.lastname: Roosen
authors.forename: Bernhard B
authors.initials: BB
authors.lastname: Singer
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bastian
authors.forename: Süleyman
authors.initials: S
authors.lastname: Ergün
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.forename: Oliver
authors.initials: O
authors.lastname: Reich
authors.forename: Derya
authors.initials: D
authors.lastname: Tilki
mesh_terms: D000368:Aged; D003287:Contrast Media; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D014465:Ultrasonics; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D017430:Prostate-Specific Antigen