COMPARISON OF CONTRAST-ENHANCED COLOR DOPPLER TARGETED BIOPSY WITH SYSTEMATIC BIOPSY: IMPACT ON PROSTATE CANCER DETECTION IN MEN WITH PSA BETWEEN 4 TO 10

Purpose: We performed a prospective study to compare contrast enhanced color Doppler ultrasound (US) targeted biopsy with gray scale US guided systematic biopsy for prostate cancer detection in men with elevated prostate specific antigen (PSA) levels between 4 to 10 ng/mL.

Methods and Materials: We examined 380 male screening volunteers with a total PSA of 4.0 ng/mL to 10 ng/mL (free-to-total PSA ratio <18%). Two independent examiners evaluated each patient and a single investigator performed 5 or fewer contrast enhanced color Doppler targeted biopsies into hypervascular regions in the peripheral zone. Subsequently another examiner performed 10 systematic prostate biopsies. The cancer detection rates of the two techniques were compared. We further evaluated the overall cancer detection rate.

Results: The overall cancer detection rate with combination of the two methods was 37.6% (143 patients) with a mean PSA of 6.2 ng/mL. The cancer detection rate was 27.4% (104 patients) for contrast enhanced color Doppler targeted biopsies, and 27.6% (105 patients) for systematic biopsy, and the detection rate of the combined methods lies above the 95% confidence interval limit of both the enhanced color Doppler targeted biopsies and for the systematic biopsy. The detection rate for targeted biopsy cores (32.6% or 233 of 715 cores) was significantly better than for systematic biopsy cores (17.9% or 257 of 1430 cores, p<0.01). Contrast enhanced targeted biopsy in a patient with cancer was 3.1-fold more likely to detect prostate cancer than systematic US guided biopsy.

Conclusions: The combined approach of contrast enhanced color Doppler targeted biopsy with systematic biopsy allows for maximal cancer detection in men with PSA levels between 4 and 10 ng/mL.