MAAUA: MAAUA 68th Annual Meeting Abstracts - Improved Detection of Prostate Cancer Using Contrast-enhanced Transrectal Ultrasound with Flash Replenishment Imaging

MAAUA 68th Annual Meeting Abstracts

Improved Detection of Prostate Cancer Using Contrast-enhanced Transrectal Ultrasound with Flash Replenishment Imaging
Edouard J Trabulsi, *Daniel D Sackett, *Flemming Forsberg, Leonard G Gomella, *Ethan J Halpern
Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA

Introduction:
We evaluated prostate cancer detection using contrast-enhanced transrectal ultrasound with flash replenishment imaging (FRI) targeted biopsies.
Materials & Methods:
209 patients referred for prostate biopsy were evaluated by transrectal US using an AplioTM scanner (Toshiba). A microbubble contrast agent, perflutren lipid microspheres (DefinityTM, Lantheus Medical Imaging, Inc.) was used. Enhanced and unenhanced US assessed abnormal echotexture or vascularity of the prostate, including standard grayscale, color/power Doppler, and FRI. FRI is a technique that uses high power flash pulses to destroy bubbles, followed by low power pulses to demonstrate contrast replenishment and depict vascular architecture. Up to 6 targeted biopsy cores were obtained from areas of abnormal vascular enhancement or morphology on FRI, followed by a blinded systematic 12 core biopsy.
Results:
Prostate cancer was found in 339/3427 cores from 82/209 (39%) of subjects. Positive biopsies were obtained in 199/2508 (7.9%) of systematic cores and 140/919 (15.2%) of targeted cores. Among patients with a positive biopsy, the odds ratio for a positive core with targeted biopsy versus systematic biopsy was 3 (95% CI: 2.2-4.1, p<0.001). Mean percentage of systematic biopsy core involvement was 32% among patients with a positive targeted core, compared with 17% among patients who were missed by targeted biopsy (p6) was more common among patients with a positive targeted biopsy (48% versus 16%; p=0.005).
Conclusions:
Targeted prostate biopsy using FRI selectively detects high volume cancer with Gleason scores of 7 and higher. Low volume cancer and Gleason <7 is less frequently detected by FRI-targeted biopsy cores.

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