Dutasteride prior to contrast-enhanced colour Doppler ultrasound prostate biopsy increases prostate cancer detection

Objectives: This study assessed the effect of premedication with dutasteride, a dual 5 alpha-reductase inhibitor, on prostatic blood flow prior to prostate biopsy and its impact on prostate cancer detection. Methods: Thirty-six patients, aged 52-74 yr, with elevated prostate-specific antigen (PSA) levels (>= 1.25 ng/ml and free-to-total ratio of <18%) were treated with dutasteride 14 d prior to prostate biopsy. Contrast-enhanced colour Doppler (CECD) ultrasound was performed before and 7 and 14 d after dutasteride treatment. Contrast-enhanced targeted biopsies (<= 5) were performed into hypervascular areas of the peripheral zone only. Subsequently, a second investigator performed 10 systematic biopsies of the prostate in a standard spatial distribution guided by conventional grey-scale ultrasonography on a Combison 530MT unit. Results: Dutasteride reduced prostatic blood flow in benign prostatic tissue, whereas in prostate cancer areas blood flow was still observed after a 14-d course of dutasteride intake. A reduction of blood flow was observed even after 7 d. Maximum flow reduction was observed after 14 d. Twelve patients (33%) of our cohort were found to have suspicious blood flow and prostate cancer and six cancers (17%) were detected solely by targeted contrast-enhanced biopsy. Conclusion: Premedication with dutasteride seems promising to improve prostate cancer detection by using CECD ultrasound. (C) 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved.