Influence of Serum Prostate-Specific Antigen (PSA) Level, Prostate Volume, and PSA Density on Prostate Cancer Detection With Contrast-Enhanced Sonography Using Contrast-Tuned Imaging Technology

Objectives-The purpose of this study was to evaluate the influence of the serum prostate-specific antigen (PSA) level, prostate volume, and PSA density on prostate cancer detection with contrast-enhanced sonography using contrast-tuned imaging technology compared with baseline imaging (combination of grayscale and power Doppler imaging). Methods-In all, 161 patients were evaluated with grayscale, power Doppler, and contrast-tuned imaging. Biopsy was performed at 10 sites in each patient. When an abnormality was shown on any of these examinations, the biopsy was directed toward the abnormality. Cancer detection between contrast-tuned imaging and baseline imaging was compared for different subgroups according to PSA level (4-10, 10-20, and >20 ng/mL), prostate volume (<35, 35-50, 50-65, and >65 mL), and PSA density (<0.15, 0.15-0.30, 0.30-0.50, and >0.50). Results-In total, 413 sites were malignant in 78 patients. By biopsy site, the accuracy was greater for contrast-tuned imaging than for baseline imaging in all PSA level, prostate volume, and PSA density subgroups except 0.30 to 0.50 (all P<.05). Contrast-tuned imaging had significantly higher sensitivity in the subgroups with PSA levels between 4 and 20 ng/mL,, prostate volumes between 35 and 65 mL,, and PSA densities between 0.15 and 0.50 than baseline imaging (all P<.05); it also had significantly higher specificity for all PSA level subgroups except 10 to 20 ng/mL,, all prostate volume subgroups except 35 to 50 mL, and all PSA density subgroups except 0.30 to 0.50 (all P<.05). Conclusions-Contrast-tuned imaging could improve cancer detection over baseline imaging in patients with,different PSA levels, prostate volumes, and PSA densities.