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      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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      Read the latest news



      Health Medicine


      Today’s Headlines

       

      “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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