Prostate Cancer: Contrast-enhanced US for Detection

Halpern, Ethan J.; Rosenberg, Martin; Gomella, Leonard G.

doi:10.1148/radiology.219.1.r01ap21219

Cited by 160 publications

(70 citation statements)

References 33 publications

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“…First, our [1,[17][18][19][20][21]. Second, the efficacy of CE sonography might be underestimated because of the limitations of our study, wherein the histologic results of biopsy were considered to be the reference standard and histologic examination of the entire prostate gland was not performed.…”

Section: Discussionmentioning

confidence: 93%

“…rostate cancer is a common malignant neoplasm in men. Its incidence has been increasing because of improvements in diagnostic testing, increasing life expectancy, and the presence of environmental carcinogens [1,2]. Although sonography has wisely been used for evaluating the prostate, many reports have shown the limitations of sonography for cancer detection based on its unsatisfactory sensitivity and variable accuracy [3][4][5][6][7][8].…”

Section: Contrast-enhancedmentioning

confidence: 99%

“…Halpern et al [1], in an early large study, showed significant improvement of the sensitivity from 38% on gray-scale and color or power Doppler sonography to 65% with contrast-enhanced (CE) sonography. Thereafter, several studies also reported an increased sensitivity of up to 86% [9][10][11][12].…”

Section: Contrast-enhancedmentioning

confidence: 99%

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Contrast-Enhanced Sonography for Prostate Cancer Detection in Patients with Indeterminate Clinical Findings

Kim

et al. 2006

American Journal of Roentgenology

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G e n i t o u r i n a r y I m a g i n g • O r i g i n a l R e s e a r c h Contrast-EnhancedOBJECTIVE. The purpose of our study was to evaluate the usefulness of contrast-enhanced sonography for prostate cancer detection in patients with an indeterminate prostate-specific antigen (PSA) level (4-10 ng/mL) and negative findings on digital rectal examination.SUBJECTS AND METHODS. Forty-eight patients underwent gray-scale, color Doppler, and contrast-enhanced sonography examinations and then sonographically guided biopsy. Contrast-enhanced sonography was performed using Levovist at a mechanical index of 1.1-1.4. The performances of the three methods for cancer detection were compared according to biopsy site and patient.RESULTS. Sensitivity by biopsy site was greater on contrast-enhanced sonography (68%) than on gray-scale (39%) and color Doppler (41%) sonography (p ≤ 0.05), whereas the specificity and overall accuracy by biopsy site (82% and 77% for gray-scale sonography, 84% and 79% for color Doppler sonography, and 83% and 81% for contrast-enhanced sonography, respectively) were not different for the three methods (p > 0.05). The concordance score for sonography and biopsy results by patient was not different for gray-scale (6.4 ± 1.8), color Doppler (6.3 ± 0.6), and contrast-enhanced sonography (6.5 ± 0.7) (p = 0.281).CONCLUSION. Contrast-enhanced sonography could improve only the sensitivity for cancer detection in analysis by biopsy site but did not improve the overall performance of sonography in patients with an indeterminate PSA level and negative digital rectal examination. rostate cancer is a common malignant neoplasm in men. Its incidence has been increasing because of improvements in diagnostic testing, increasing life expectancy, and the presence of environmental carcinogens [1,2]. Although sonography has wisely been used for evaluating the prostate, many reports have shown the limitations of sonography for cancer detection based on its unsatisfactory sensitivity and variable accuracy [3][4][5][6][7][8].Over the past few years, microbubble contrast-enhanced sonography has been introduced as a promising tool that can improve prostate cancer detection. Halpern et al. [1], in an early large study, showed significant improvement of the sensitivity from 38% on gray-scale and color or power Doppler sonography to 65% with contrast-enhanced (CE) sonography. Thereafter, several studies also reported an increased sensitivity of up to 86% [9][10][11][12]. However, the actual merit of sonographic contrast material may be in question because the performance of CE sonography varied in those studies. The variable degree of cancer risk in the study populations of previous studies may be largely responsible for the variable results of those studies; patients with a high PSA level and positive digital rectal examination may have a greater chance of having positive sonographic findings than those with an indeterminate risk of prostate cancer [9][10][11][12][13][14]. Therefore, if CE sonography were shown to have improved ...

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Section: Discussionmentioning

confidence: 93%

Section: Contrast-enhancedmentioning

confidence: 99%

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Contrast-Enhanced Sonography for Prostate Cancer Detection in Patients with Indeterminate Clinical Findings

Kim

et al. 2006

American Journal of Roentgenology

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“…Two other investigations of PI HI TRUS in men scheduled for biopsy have been reported in the literature (both by our group and using other ultrasonographic contrast agents). 19,22 The largest of the 2 involved 60 patients, and the accuracy of PI HI TRUS (75%) was found to be significantly higher than that of conventional TRUS (64%; P = .027). 22 The differences between that study and the results reported here are most likely due to the much higher prevalence of cancer induced in the dogs (9 [60%] of 15 had cancer) compared with the prevalence in the patient population at our institution (30%-35%).…”

Section: Discussionmentioning

confidence: 93%

“…Doppler enhancement of the intraprostatic vessels has also been shown with other ultrasonographic contrast agents, mainly in smaller feasibility studies. [21][22][23][24] We previously described a radial, spokelike intraprostatic vascular pattern after Sonazoid injection in both healthy dogs and healthy men. 20,37 A disturbance of this normal radial vascular pattern appears to indicate areas of disease.…”

Section: Discussionmentioning

confidence: 99%

Contrast-Enhanced Transrectal Ultrasonography of a Novel Canine Prostate Cancer Model

Forsberg

Johnson²,

Merton

et al. 2002

Journal of Ultrasound in Medicine

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Objective. This study evaluated the utility of a new animal model for prostate cancer imaging using a new ultrasonographic contrast agent (Sonazoid [NC100100]; Amersham Health, Oslo, Norway), for prostate cancer detection. Methods. Twenty-four dogs had a canine transmissible venereal sarcoma cell line injected (50 million cells/mL) directly into the prostate, producing a neoplasm in 15 to 40 days. Transrectal ultrasonography was performed in power Doppler mode on 8 dogs (phase I) and in gray scale phase inversion harmonic imaging mode on 16 animals (including control animals without tumors; phase II). Evaluations were repeated after intravenous injections of the contrast agent (dose, 0.00625-0.20 µL/kg). Histopathologic examination was performed after each study. For the phase II experiments, sensitivity, specificity, and accuracy were calculated. Results. The contrast agent improved visualization of the prostate cancer vascularity and delineation of tumor size and shape in both power Doppler and phase inversion harmonic imaging modes. Canine transmissible venereal sarcoma tumors ranging from 3 × 5 to 40 × 50 mm were detected. The accuracy for detecting the number of prostate tumors increased (in phase II) from 67% to 87% with the addition of the contrast agent. Histopathologic examination confirmed the ultrasonographic findings and revealed typical canine transmissible venereal sarcoma cells infiltrating the prostate with moderate neovascularity. Conclusions. The novel canine tumor model was useful for evaluating ultrasonographic prostate imaging techniques. Improved detection of prostate tumors in dogs was possible with gray scale phase inversion harmonic imaging of the contrast agent. The accuracy of lesion detection increased from 67% to 87%. Key words: animal model; phase inversion harmonic imaging; prostate cancer; ultrasonographic contrast agent.

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Regional-Level Correlations in Inappropriate Imaging Rates for Prostate and Breast Cancers

et al. 2015

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IMPORTANCE The association between regional norms of clinical practice and appropriateness of care is incompletely understood. Understanding regional patterns of care across diseases might optimize implementation of programs like Choosing Wisely, an ongoing campaign to decrease wasteful medical expenditures. OBJECTIVE To determine whether regional rates of inappropriate prostate and breast cancer imaging were associated. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study using the the Surveillance, Epidemiology, and End Results–Medicare linked database. We identified patients diagnosed from 2004 to 2007 with low-risk prostate (clinical stage T1c/T2a; Gleason score, ≤6; and prostate-specific antigen level, <10 ng/mL) or breast cancer (in situ, stage I, or stage II disease), based on Choosing Wisely definitions. MAIN OUTCOMES AND MEASURES In a hospital referral region (HRR)-level analysis, our dependent variable was HRR-level imaging rate among patients with low-risk prostate cancer. Our independent variable was HRR-level imaging rate among patients with low-risk breast cancer. In a subsequent patient-level analysis we used multivariable logistic regression to model prostate cancer imaging as a function of regional breast cancer imaging and vice versa. RESULTS We identified 9219 men with prostate cancer and 30 398 women with breast cancer residing in 84 HRRs. We found high rates of inappropriate imaging for both prostate cancer (44.4%) and breast cancer (41.8%). In the first, second, third, and fourth quartiles of breast cancer imaging, inappropriate prostate cancer imaging was 34.2%, 44.6%, 41.1%, and 56.4%, respectively. In the first, second, third, and fourth quartiles of prostate cancer imaging, inappropriate breast cancer imaging was 38.1%, 38.4%, 43.8%, and 45.7%, respectively. At the HRR level, inappropriate prostate cancer imaging rates were associated with inappropriate breast cancer imaging rates (ρ = 0.35; P < .01). At the patient level, a man with low-risk prostate cancer had odds ratios (95% CIs) of 1.72 (1.12–2.65), 1.19 (0.78–1.81), or 1.76 (1.15–2.70) for undergoing inappropriate prostate imaging if he lived in an HRR in the fourth, third, or second quartiles, respectively, of inappropriate breast cancer imaging, compared with the lowest quartile. CONCLUSIONS AND RELEVANCE At a regional level, there is an association between inappropriate prostate and breast cancer imaging rates. This finding suggests the existence of a regional-level propensity for inappropriate imaging utilization, which may be considered by policymakers seeking to improve quality of care and reduce health care spending in high-utilization areas.

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Prostate Cancer: Contrast-enhanced US for Detection

Abstract: Enhanced transrectal sonography improves sensitivity for the detection of malignant foci within the prostate without substantial loss of specificity. Low-volume tumors with a Gleason score of 6 or less may not be detected with enhanced transrectal sonography.

Cited by 160 publications

References 33 publications

Contrast-Enhanced Sonography for Prostate Cancer Detection in Patients with Indeterminate Clinical Findings

Contrast-Enhanced Sonography for Prostate Cancer Detection in Patients with Indeterminate Clinical Findings

Contrast-Enhanced Transrectal Ultrasonography of a Novel Canine Prostate Cancer Model

Regional-Level Correlations in Inappropriate Imaging Rates for Prostate and Breast Cancers

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