Transrectal Broadband-Doppler Sonography with Intravenous Contrast Medium Administration for Prostate Imaging and Biopsy in Men with an Elevated PSA Value and Previous Negative Biopsies

Abstract

The aim of this study was to determine the prostate cancer detection rate of targeted biopsy using contrast-enhanced ultrasound (US) in patients with elevated prostate specific antigen (PSA) levels and previous negative biopsy. Patients and Methods: A total of 114 patients initially underwent ultrasonography using transrectal ultrasound (TRUS) and power Doppler. All the patients had at least one previous biopsy series negative for prostate carcinoma. Ninety-five of the patients were examined with a new broadband Doppler technique, advanced dynamic flow (ADF), after i.v. injection of the echo enhancer (2.4 ml, SonoVue). The systematic biopsies were also obtained supplemented by removal of two targeted tissue cores in all the patients with a suspicious area in the inflow phase or late phase. Results: Histology confirmed prostate cancer in 30 of the 95 patients. Sensitivity for the detection of prostate cancer by contrast-enhanced US was 100% and specificity was 48%. Suspicious areas were identified in 48 cases including 40 hypervascularized areas and 14 hypoechoic areas after 60 sec. Targeted biopsy identified 24 of the 30 carcinomas. Randomized octant biopsy identified only 8 of the 30 carcinomas. All 65 patients with negative histology were prostate cancer free at 12-month follow-up. The ADF US scans were degraded by fewer artifacts than the power Doppler images. Conclusion: Contrast-enhanced ADF Doppler allows reliable differentiation of prostate cancer and normal prostate tissue with a high sensitivity in patients with previous negative biopsy and fewer artifacts than power Doppler images, thus providing a good basis for targeted prostate biopsy instead of systematic biopsy.