Contrast-enhanced transrectal ultrasound (CE-TRUS) with cadence-contrast pulse sequence (CPS) technology for the identification of prostate cancer.
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.
Seitz
Michael
M
Department of Urology, Hospital of the University of Munich-Campus Grosshadern, Munich, Germany. michael.seitz.@med.uni-muenchen.de
Gratzke
Christian
C
Schlenker
Boris
B
Buchner
Alexander
A
Karl
Alexander
A
Roosen
Alexander
A
Singer
Bernhard B
BB
Bastian
Patrick J
PJ
Ergün
Süleyman
S
Stief
Christian G
CG
Reich
Oliver
O
Tilki
Derya
D
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
D003287:Contrast Media; D017430:Prostate-Specific Antigen