New High-Res Ultrasound Trial for Prostate Cancer Detection Underway at Johns Hopkins Bayview

Christian Pavlovich, MD

Christian Pavlovich, M.D. and colleagues at the Brady Urological Institute at Johns Hopkins Bayview are leading a 5-institution study of a novel high-resolution transrectal ultrasound machine for prostate cancer detection. Dr. Pavlovich is the Principal Investigator of this multinational trial, which was designed to compare an exciting new ultrasound technology with conventional transrectal ultrasound (TRUS) to guide prostate biopsy. This trial is being spearheaded at Johns Hopkins Bayview because of promising data from an initial study authored by Pavlovich's group that showed high-resolution ultrasound to be superior to conventional ultrasound in identifying prostate cancerous lesions.[1]

(A) Reconstructed sagittal prostate
section with Gleason 3 + 4 = 7 tumor at
left apex outlined in green ink. This
corresponds to a  hypoechoic lesion most
 accurately identified on high-resolution
transrectal ultrasound (B).  The lesion is less
clearly defined on low-resolution transrectal
ultrasound and could be missed (C). [1]

Conventional TRUS is performed at low frequencies (7-12 MHz) that enhance tissue penetration, but this limits resolution at the peripheral zone of the prostate, where more than 80% of prostate cancers are located. High-frequency TRUS on the other hand, operates in the 16-21 MHz range, which permits far greater resolution of prostatic architecture, particularly in the peripheral zone of the prostate. See the results from the initial study of high-resolution ultrasound on the left, note the correlation between pathological analysis of prostate tissue, high-resolution and standard ultrasound.  New anatomic differences between prostate cancers and benign prostate tissue are currently being elucidated with the high-resolution machine. See more images of high-resolution ultrasound below. The study team is hopeful that this new technology will allow for more accurate detection of clinically significant prostate cancers.

Far less cumbersome than prostate MRI, high-resolution TRUS imaging of the prostate is done at the same setting as the biopsy, takes less than 15 minutes to perform, and does not involve an intravenous contrast agent. If the data continue to be promising, this new imaging technology may one day become an important part of prostate cancer diagnosis and surveillance.

The current trial is open to men without a known diagnosis of prostate cancer who have indications for prostate biopsy (rising PSA, elevated PSA, and/or abnormal digital rectal examination), and involves a consultation and examination, followed by a TRUS-guided prostate biopsy. Pathologic review of the specimens is then done by world class genitourinary pathologists at Johns Hopkins.

High-resolution ultrasound demonstrating a benign prostatic hyperplasia (BPH)
nodule (top) and prostate cancer (below).

The study is currently open at Johns Hopkins Bayview and at 4 other sites in North America. Interested patients and health care providers should feel free to contact study coordinator Lynda Mettee, P.A.-C., at (410) 550-1700 or at LZIEMSK1@JHMI.EDU, Lori Perry, Sr L.P.N. at (410) 550-9135 or at LPERRY1@JMHMI.EDU, or Dr. Pavlovich at CPAVLOV2@JHMI.EDU.

[1]  Pavlovich CP, Cornish TC, Mullins JK, Fradin J, Mettee LZ, Connor JT, Reese AC, Askin FB, Luck R, Epstein JI, Burke HB.  High-resolution transrectal ultrasound: pilot study of a novel technique for imaging clinically localized prostate cancer.  Urol Oncol. 2014 Jan;32(1):34.e27-32. doi: 10.1016/j.urolonc.2013.01.006. Epub 2013 Apr 2.