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Contrast-Enhanced Transrectal Ultrasound in Focal Therapy for Prostate Cancer

Current Urology Reports volume 19, Article number: 87 (2018) Cite this article

Abstract

Purpose of Review

Contrast-enhanced transrectal ultrasound (CeTRUS) is an emerging imaging technique in prostate cancer (PCa) diagnosis and treatment. We review the utility and implications of CeTRUS in PCa focal therapy (FT).

Recent Findings

CeTRUS utilizes intravenous injection of ultrasound-enhancing agents followed by high-resolution ultrasound to evaluate tissue microvasculature and differentiate between benign tissue and PCa, with the latter demonstrating increased enhancement. The potential utility of CeTRUS in FT for PCa extends to pre-, intra- and post-operative settings. CeTRUS may detect PCa, facilitate targeted biopsy and aid surgical planning prior to FT. During FT, the treated area can be visualized as a well-demarcated non-enhancing zone and continuous real-time assessment allows immediate re-treatment if necessary. Following FT, the changes on CeTRUS are immediate and consistent, thus facilitating repeat imaging for comparison during follow-up. Areas suspicious for recurrence may be detected and target-biopsied. Enhancement can be quantified using time-intensity curves allowing objective assessment and comparison.

Summary

Based on encouraging early outcomes, CeTRUS may become an alternative imaging modality in prostate cancer FT. Further study with larger cohorts and longer follow-up are needed.

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Fig. 1

Abbreviations

CEUS:

Contrast-enhanced ultrasound

CeTRUS:

Contrast-enhanced transrectal ultrasound

DCE:

Dynamic contrast-enhancement

DWI:

Diffusion-weighted imaging

HIFU:

High-intensity focused ultrasound

IRE:

Irreversible electroporation

mpMRI:

Multiparametric magnetic resonance imaging

MRI:

Magnetic resonance imaging

PCa:

Prostate cancer

PI:

Peak intensity

PSA:

Prostate-specific antigen

ROI:

Region of interest

TIC:

Time-intensity curve

TTP:

Time-to-peak

UEA:

Ultrasound-enhancing agents

US FDA:

United States Food and Drug Administration

WIS:

Wash-in slope

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Affiliations

  1. USC Institute of Urology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA

    Akbar N. Ashrafi, Nima Nassiri, Inderbir S. Gill, Daniel Park & Andre L. de Castro Abreu

  2. Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Mittul Gulati

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  1. Akbar N. Ashrafi
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  2. Nima Nassiri
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Correspondence to Andre L. de Castro Abreu.

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Akbar N. Ashrafi, Nima Nassiri, Inderbir S. Gill, Mittul Gulati, Daniel Park, and Andre L. de Castro Abreu each declare no potential conflicts of interest.

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Ashrafi, A.N., Nassiri, N., Gill, I.S. et al. Contrast-Enhanced Transrectal Ultrasound in Focal Therapy for Prostate Cancer. Curr Urol Rep 19, 87 (2018). https://doi.org/10.1007/s11934-018-0836-6

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Keywords

  • Contrast-enhanced
  • Ultrasound-enhancing agents
  • Focal therapy
  • HIFU
  • Microbubbles
  • Prostate cancer