Comparison of contrast enhanced color doppler targeted biopsy to conventional systematic biopsy in carcinoma prostate.

Induja, J (2014) Comparison of contrast enhanced color doppler targeted biopsy to conventional systematic biopsy in carcinoma prostate. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : One of the most common cancers diagnosed in men is carcinoma prostate. Because of improvements in diagnostic testing, its incidence has been increasing. In patients with carcinoma prostate, ultra sonogram guided biopsy has been the investigation of choice in men with increased serum prostate specific antigen or a nodular prostate. Targeted biopsies will be helpful in increasing the sensitivity of systematic biopsy. Micro-bubble contrast agents are used as innovative technology to enhance detection of prostate cancer. Several studies have demonstrated that contrast enhanced ultrasound (CEUS) of prostatic blood flow helps in visualization of cancerous lesion and to target biopsy. Biopsy from target lesion helps in detecting more cancers with lesser cores .CEUS has been shown to detect cancers with higher Gleason scores, which improves cancer grading. Micro bubble contrast agent images the microvasculature in the prostate, especially in carcinoma, these contrast agents increase the sensitivity in detecting carcinomatous lesions. We undertook this study to find the efficacy of CE sonography for detection of prostate in patients with PSA >4 ng/ml and compare this with conventional system. AIM AND OBJECTIVE : To assess the efficacy of contrast enhanced color Doppler ultrasound guided biopsy to detect prostate cancer. To compare prostate cancer detection with contrast enhanced ultrasound compared and conventional systematic biopsy and the impact on Gleason score. MATERIALS AND METHODS : Informed consent was obtained from all the patients. The patients were started on prophylactic antibiotic the night before biopsy. on the morning of biopsy, a cleansing enema was given for the patient. Aspirin or nonsteroidal anti-inflammatory agents are withheld for at least 5 days before biopsy. Transrectal ultrasound examination of the prostate, TRUS examination during infusion of contrast material, and biopsy of the prostate are all done during a single visit. Transrectal sonography was performed with Siemens ultrasound machine for all patients. Contrast enhanced sonography was done using sonovue, as the ultrasound contrast agent. The lyophilized powder is shaken with 5 mL of distilled water for 20 sec. By using a 20-gauge cannula, 1.5 ml contrast agent bolus was injected into the left antecubital vein manually. 1 ml solution contains 8ug/ml. 5 ml of normal saline is injected each time, after injecting the ultrasound contrast agent. Inclusion Criteria: Patients with serum prostate specific antigen > 4 ng/ml. Normal or abnormal digital rectal examination Exclusion Criteria: 1. Active UTI, 2. Prostatitis, 3. Un Co-Operative Patients, 4. Allergy to ultrasound contrast agents, 5. Contra-indications to ultrasound contrast agents like -Recent acute myocardial infarction (< 7 days), Right-to-left shunts, Class III / IV cardiac failure, and severe pulmonary hypertension. CONCLUSION : The results of this study shows that, The sensitivity and accuracy of cancer detection is improved by using ultrasound contrast agents for depicting microvessels in carcinoma prostate. The use contrast agents in TRUS will help in targeted biopsy of the enhancing lesions thereby decreasing the number of biopsy cores and associated complication. The use of CEUS also may be useful in patients with indeterminate serum PSA. Targeted biopsy has a definite impact on gleason scores, detecting high grade cancers with limited number of cores thus helping in planning the treatment in carcinoma prostate.

Item Type: Thesis (Masters)
Uncontrolled Keywords: contrast enhanced color doppler ; biopsy ; conventional systematic biopsy ; carcinoma prostate ; Comparison study.
Subjects: MEDICAL > Urology
Depositing User: Kambaraman B
Date Deposited: 10 Aug 2017 02:24
Last Modified: 10 Aug 2017 06:15

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