Department of Radiology, Jefferson Prostate Diagnostic Center, Thomas Jefferson University, Philadelphia, Pennsylvania 19107-5244, USA.
J Urol. 2012 Nov;188(5):1739-45. doi: 10.1016/j.juro.2012.07.021. Epub 2012 Sep 19.
The identification of clinically significant disease is crucial for optimal treatment of prostate cancer. Selective detection of prostate cancer with increased microvessel density is possible with contrast enhanced ultrasound. Preliminary studies suggest that pretreatment with a 5α-reductase inhibitor may improve the efficiency of contrast enhanced ultrasound targeted biopsy. This study was designed to quantify prostate cancer detection with contrast enhanced ultrasound with or without short-term pretreatment with dutasteride.
In this randomized, double-blind, placebo controlled trial of oral dutasteride pretreatment, contrast enhanced ultrasound findings were graded and used to direct targeted biopsy (up to 6 cores per prostate). A blinded 12-core systematic biopsy was subsequently performed on every subject based on standard medial and lateral sampling of each sextant.
Of 311 subjects who underwent randomization, 272 completed participation. Positive biopsies were obtained in 276 of 3,264 (8.5%) systematic cores and 203 of 1,237 (16.4%) targeted cores (OR 2.1, 95% CI 1.7-2.6, p <0.001). ROC analysis for the detection of all prostate cancers demonstrated an increase in diagnostic accuracy from pre-contrast imaging to contrast enhanced ultrasound (A(z) 0.60 vs 0.64, p = 0.005). For the detection of high grade cancer (Gleason score 7 or greater) ROC analysis demonstrated improved accuracy for pre-contrast imaging (A(z) 0.74) and contrast enhanced ultrasound (A(z) 0.80, p = 0.0005). For the detection of high grade cancer with greater than 50% biopsy core involvement, excellent accuracy was demonstrated with pre-contrast and contrast enhanced ultrasound, A(z) 0.83 and 0.90, respectively (p = 0.001). Pretreatment with dutasteride had no significant impact on the detection of prostate cancer (p = 0.97).
Contrast enhanced ultrasound targeted biopsy provides a significant benefit for the detection of high grade/high volume prostate cancer.
识别临床上有意义的疾病对前列腺癌的最佳治疗至关重要。通过增强超声检测微血管密度可以选择性地检测前列腺癌。初步研究表明，用 5α-还原酶抑制剂预处理可能会提高增强超声靶向活检的效率。本研究旨在量化使用或不使用 dutasteride 短期预处理的增强超声检测前列腺癌的效果。
在这项随机、双盲、安慰剂对照的 dutasteride 口服预处理试验中，对增强超声结果进行分级，并用于指导靶向活检（每个前列腺最多 6 针）。随后，根据每个六分区的标准中间和外侧采样，对每位受试者进行盲法 12 针系统活检。
在接受随机分组的 311 名受试者中，有 272 名完成了研究。在 3264 个系统核心中的 276 个（8.5%）和 1237 个靶向核心中的 203 个（16.4%）获得了阳性活检（OR 2.1，95%CI 1.7-2.6，p <0.001）。用于检测所有前列腺癌的 ROC 分析显示，从对比前成像到增强超声的诊断准确性有所提高（A（z）0.60 对 0.64，p = 0.005）。对于检测高级别癌症（Gleason 评分 7 或更高），ROC 分析显示对比前成像（A（z）0.74）和增强超声（A（z）0.80）的准确性提高（p = 0.0005）。对于检测高级别癌症（Gleason 评分 7 或更高），ROC 分析显示对比前成像（A（z）0.74）和增强超声（A（z）0.80）的准确性提高（p = 0.0005）。对于检测有 50%以上活检核心参与的高级别癌症，对比前和增强超声都具有极好的准确性，A（z）分别为 0.83 和 0.90（p = 0.001）。dutasteride 预处理对前列腺癌的检测没有显著影响（p = 0.97）。
增强超声靶向活检对检测高级别/大容量前列腺癌具有显著优势。
