Can Sonovue targeted biopsy replace extended or saturation biopsy in prostate cancer diagnosis? Our experience at primary and repeat biopsy.
OBJECTIVE
To evaluate the detection rate of prostate cancer (PCa) at initial and repeat biopsy in patients submitted to Sonovue targeted biopsy vs extended or saturation prostate biopsy (SPBx).


METHODS
From November 2007 to April 2008 60 patients aged 64 years (median) underwent extended TRUS-guided transperineal prostate biopsy. Indications to biopsy were: abnormal DRE, PSA > 10 ng/mL; PSA included between 2.6 and 4.0 and 4.1 and 10 ng/mL with %free/total PSA < or = 20% and < or = 25%, respectively. In 45 and 15 men prostate biopsy was performed as primary and repeated procedure respectively; median PSA was 8.3 ng/mL vs 11.8 ng/mL and digital rectal examination was positive in 9 vs 3 patients, respectively. Before performing extended or SPBx scheme in case of primary (19 cores) and repeated (28 cores) procedure, prostate areas characterized by absence of enhancement after Sonovue (2.4 mg) administration on gray scale during continuous harmonic imaging (HI) contrast-enhanced ultrasound (CEUS) were considered suspicious for PCa and submitted to targeted biopsy.


RESULTS
3.5 (median) targeted biopsies were performed in the peripheral zone of 22 men. In patients who underwent primary and repeated biopsy PCa was detected in 20/45 (44.5%) and 3/15 (20%) cases, but Sonovue detected only 6/20 (30%) and 1/3 (33.4%) of cancers, respectively. Sensitivity and specificity of Sonovue in diagnosing PCa was equal to 30.0% and 61.5% (primary biopsy) vs 33.4% and 54.5% (repeated biopsy).


CONCLUSIONS
Based on its low diagnostic accuracy, Sonovue CEUS HI targeted biopsy can not replace extended or SPBx in diagnosing PCa.
Urology Unit, Cannizzaro Hospital, Catania, Italy. piepepe@hotmail.com
Pietro
P
Pepe
Giuseppe
G
Candiano
Michele
M
Pennisi
Francesco
F
Aragona
D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D011471:Prostatic Neoplasms / Q000473:pathology*; D013459:Sulfur Hexafluoride
D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride