Monitoring Blood Flow Helps Improve Prostate Biopsies, Jefferson Researchers Report
Using
a special ultrasound technique to spot areas of blood flow in the
prostate gland may substantially reduce the number of unnecessary
biopsies, according to a new study by urologists and radiologists at
the Jefferson Prostate Diagnostic Center and the Kimmel Cancer Center
at Jefferson in Philadelphia. The researchers found that biopsies
targeted to areas of increased blood flow in the prostate were twice as
likely to be positive for cancer compared with conventional prostate
biopsy techniques. They reported their initial results from a clinical
trial this week at the annual meeting of the American Urological
Association in Orlando.
According
to Prostate Diagnostic Center co-director Edouard Trabulsi, M.D.,
assistant professor of Urology at Jefferson Medical College of Thomas
Jefferson University, finding the best areas to perform biopsies in the
prostate has always been difficult. Standard methods entail simply
dividing the prostate into a dozen regions within the gland, almost
randomly. Center co-director Ethan Halpern, M.D., 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.
Dr.
Trabulsi, Ethan Halpern, M.D., professor of Radiology and Urology at
Jefferson Medical College, and their co-workers randomly divided 63
prostate biopsy patients into two groups. One group was given the drug
dutasteride, which can reduce the blood flow in benign prostate tissue,
while the other half received a placebo. They then compared the results
from biopsies targeted by blood flow changes using contrast-enhanced
ultrasound to those that were done the standard way. The study involved
979 biopsies.
“We’ve
previously shown that a two-week course of the drug Avodart
(dutasteride) before biopsy reduces the benign blood flow, or
background noise,” Dr. Trabulsi explains, “allowing us to see subtle
flow changes to target for biopsy. When we did this, we found that
targeted biopsies based on the contrast-enhanced ultrasound are much
more likely to detect prostate cancer. That’s the exciting part about
this.”
Dr.
Halpern explains that standard procedures fail to diagnose prostate
cancer in approximately 30 percent of men with the disease, even though
the biopsy protocol may sample 12 to 18 tissue cores from the prostate.
“In the future, our goal is to perform a limited number of targeted
biopsies and leave the rest of the prostate alone,” he says. “This will
provide a safer, more cost-effective approach to diagnosing prostate
cancer.”
The
doctors say that the current study involves a novel ultrasound
algorithm called flash replenishment imaging to show fine vascular flow
differences. “The novelty is using the dutasteride before biopsy, using
contrast-enhanced ultrasound and using the latest ultrasound technology
to look for blood flow changes associated with prostate cancer.”
“We are beginning to have patients who were operated on come back in,” Dr. Trabulsi notes. “If we can show that we reliably
hit the areas of cancer based on the ultrasound results and didn’t miss any, it’s a home run.”
The trial is continuing and the team is hoping to enroll about 450 men in the trial. For more information, please see the
Prostate Diagnostic Center site, www.prostate.tju.edu.
Media Only Contact:
Ed Federico
Thomas Jefferson University Hospital
Phone: (215) 955-6300
Published: 5/23/2008