Health Medicine for Senior Citizens
Contrast-Enhanced Ultrasound Detects High-Grade
Prostate Cancer Using Less Biopsies
Older men in active surveillance for prostate
cancer would benefit from
using microbubble technique to watch progession
Oct. 1, 2012 Anything that reduces the necessity
of biopsies is usually welcomed by senior citizens, the most likely
victims of cancer. New research concerning prostate cancer, a common
cancer hitting older men, indicates the time has come for the use of
contrast-enhanced ultrasound to better detect high-grade prostate cancer
and monitor low-risk ones using less biopsies.
Findings from the randomized, double-blind trial
revealed the technique, which uses microbubbles to measure change in
blood flow, found almost three times as many higher grade cancers using
half as many needle biopsies compared to systematic biopsy methods.
Researchers from
Thomas Jefferson
University and Hospitals report their phase III study online
in the Journal of Urology.
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“Today, a physician may sample 12 to 18 tissue
cores from the prostate in order to help diagnose a patient. But with
contrast-enhanced, that number drops to six or even less,” says lead
author
Ethan Halpern, M.D., co-director of the
Prostate Diagnostic
Center Thomas Jefferson University Hospital and professor of
Radiology and Urology at Thomas Jefferson University.
“So it’s less invasive, and a more effective
guidance tool. We’ve found that with contrast-enhanced ultrasound, we
are much more likely to detect cancers on the image, and in this case,
the higher grades.”
Results from the clinical trial of 311 men, 118 of
which had positive prostate cancer biopsies, revealed that targeted
biopsies using contrast-enhanced ultrasound with microbubbles detected
significantly more higher volume/grade prostate cancers (clinically
significant) in men (55%) compared to a conventional prostate biopsy
technique (17%).
Ultrasound imaging of the prostate is commonly used
to assess the size of the gland and for needle placement during
systematic biopsy, but is limited by difficulty in distinguishing benign
from malignant tissue. What’s makes contrast-enhanced ultrasound
different is the microbubble contrast agents, tiny bubbles of gas
contained within a supporting shell that are injected into the patient
to help better measure changes in blood flow.
Prostate cancer, like many cancers, harbors
abnormal blood vessel flow. This change in flow in the prostate can be
measured by ultrasound; the microbubbles enhance the reflection of those
ultrasound waves.
The technique has been used with success in Europe
for some time, but researchers at Jefferson say it’s ready for primetime
in the United States. The U.S. Food and Drug Administration hasn’t
approved it for use for prostate screening, although it is used in other
imaging applications.
In the clinical trial, researchers performed both
targeted biopsies using contrast-enhanced ultrasound with flash
replenishment maximum intensity projection MicroFlow Imaging on all
patients, and a systematic 12-core biopsy protocol for comparison. The
mean age of the patients was 62 years and a PSA level of 6.5ng/mL.
“Our ultimate goal is to perform a limited number
of targeted biopsies and leave the rest of the prostate alone,” says Dr.
Halpern. “This will provide a safer, more cost-effective approach to
diagnosing prostate cancer.”
Subjects were also randomized to pretreatment with
dutasteride, a drug used to treat an enlarged prostate, and placebo;
however, no was significant difference in the proportion of positive
biopsies for prostate cancer.
Dr. Halpern, who is principal investigator on the
four-year, National Cancer Institute-supported trial, has been
developing and refining techniques to enhance targeted biopsy of the
prostate for more than a decade, along with his colleagues at
Jefferson, Edouard J.
Trabulsi, M.D., co-director of the Prostate Diagnostic Center
and associate professor of urology,
Flemming Forsberg,
Ph.D., a professor of Radiology,
Barry Goldberg, M.D.
, director of the Division of Diagnostic Ultrasound, and
Leonard Gomella, M.D.,
F.A.C.S., director for Clinical Affairs at the
Kimmel Cancer Center
at Jefferson, and Chair of the Department of Urology. Peter
A. McCue, M.D., a professor in the Department of Pathology, Anatomy and
Cell Biology at Jefferson, was also part of this study.
Because prostate cancer often grows very slowly,
some men, especially those who are older or have other serious health
problems may never need treatment. Instead they may benefit from active
surveillance where their cancers are carefully monitored with various
tests to determine if the cancer is beginning to be more aggressive.
“It stands to reason that the cost-benefit ratio
for prostate cancer screening will improve if PSA screening is followed
by a limited targeted biopsy based on contrast-enhanced ultrasound,”
said Dr. Trabulsi. “This also means contrast-enhanced ultrasound can act
as another monitoring tool for active surveillance in low-grade cancer
patients, potentially preventing unwarranted treatments.”
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