CONTRAST ENHANCED COLOR DOPPLER TARGETED AND SYSTEMATIC BIOPSY

Purpose: Transrectal gray scale ultrasound guided biopsy is the standard method for diagnos-ing prostate cancer (PC). Improved cancer detection with ultrasound contrast agents is related to better detection of tumor vascularity. We evaluated the impact of a combined approach of contrast enhanced, color Doppler targeted biopsy (CECD) and systematic biopsy (SB) for the PC detection rate in men with prostate specific antigen (PSA) 4.0 to 10 ng/ml. Materials and Methods: We examined 380 screening volunteers with a total PSA of 4.0 to 10 ng/ml (percent free PSA less than 18). CECD was always performed before SB. Another inves-tigator blinded to contrast enhanced findings performed 10 SBs. The cancer detection rate for the CECD, SB and combined approaches was assessed. Results: PC was detected in 143 of 380 patients (37.6%, mean total PSA 6.2 ng/ml). The PC detection rate for CECD and for SB was 27.4 % and 27.6%, respectively. The overall can-cer detection rate with the 2 methods combined was 37.6%. For targeted biopsy cores the detection rate was significantly better than for SB cores (32.6 % vs 17.9%, p 0.01). CECD in a patient with cancer was 3.1-fold more likely to detect PC than SB