Targeted Biopsy of the Prostate: Utility of Gray Scale, Color Doppler and Elastography for the Detection of Prostate Cancer
Craig B Slotoroff, Ethan J Halpern, Melany Grogan*, Elizabeth P Ives, Ilan Waldman, Leonard G Gomella
Thomas Jefferson University, Philadelphia, PA
Introduction
Evaluate a targeted biopsy approach utilizing gray scale sonography, color Doppler, and elastography for detecting prostate cancer.
Methods
Eighty one patients undergoing prostate biopsy were evaluated. Mean patient age was 65 years. Mean serum prostate specific antigen was 8.4ng/dl. Imaging and elastograms were performed using end-fire transrectal probe (Hi-Vision 8500; Hitachi Medical Systems). Manual compression of the prostate generated elastograms. Gray scale, color Doppler and elastography findings were graded as normal or abnormal. Up to six targeted biopsies were obtained from areas of abnormality. Six sextant biopsies were then performed.
Results
Prostate cancer was detected in 122/901 (13.5%) of biopsy cores from 32 subjects, including 52/285 (18.2%) targeted cores and 70/616 (11.4%) sextant cores. Prostate cancer was detected in 19 subjects by targeted biopsy and 32 subjects by sextant biopsy (p<0.001). Targeted cores were 2.1 times more likely to detect prostate cancer, compared to sextant cores (p = 0.005). Univariate analysis demonstrated that each ultrasound modality significantly predicted presence of malignancy (p<0.02). Multivariate conditional logistic regression analysis demonstrated increased detection of prostate cancer in areas with abnormality on gray scale (OR = 4.4, p=0.25), color Doppler (OR = 6.8, p=0.01) and elastography (OR = 9.3, p=0.03).
Conclusions
Sonographic findings on gray scale, color Doppler and elastography correlate with the presence of prostate cancer. Color Doppler and elastography provide additional information about location of prostate cancer when compared with gray scale imaging. Nonetheless, targeted biopsy approach based upon these imaging findings detected significantly fewer cancers compared to systematic sextant biopsy.
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