COMMENTARY

Targeted Biopsy May Improve Prostate Cancer Screening

Gerald Chodak, MD

Disclosures

November 19, 2012

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Hello. I'm Dr. Gerald Chodak for Medscape. Today's topic is contrast-enhanced ultrasonography, and its ability to diagnose prostate cancer. Halpern and coworkers[1] published a study in the Journal of Urology in which they compared contrast-enhanced targeted biopsies with random biopsies, using a 12-core method.

The results are interesting because although there was a higher likelihood of being diagnosed with prostate cancer using random biopsies, men who had significant cancer (defined by a Gleason score of 7, or > 50% volume in their cores) were more likely to be diagnosed using the targeted approach. The conclusion is that this may be a way of improving the results of screen-detected prostate cancers. We are well aware that one of the problems with screening is the overdiagnosis of clinically insignificant, non-life-threatening prostate cancers. Anything that could be done to shift the curve might be advantageous.

In this study, fewer biopsies were performed in the study group. The contrast-enhanced patients had up to 6 core-biopsies, compared with 12 core biopsies in the random biopsy group. That means that you have a lower risk for infection. Not everyone will need to undergo biopsies, unless they clearly show an area that warrants biopsy, with the targeted approach. In the end, this approach may provide an overall benefit by reducing the likelihood of diagnosing clinically insignificant cancer.

This was not a very large study and certainly needs confirmation. But it might pave the way for improving our outcomes, and it may make it more likely that the screen-detected cancers that we are finding could be those that are more likely to need treatment. That doesn't mean that everyone who is diagnosed using this targeted approach will need treatment, but it might allow us to define who could go into a more appropriate active surveillance group. For now, this is an interesting, important, and well-done study. It needs further validation, but in the end it may offer an improvement, with several advantages for men who are undergoing screening prostate-specific antigen (PSA).

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