title: Color Doppler-guided prostate biopsies in 591 patients with an elevated serum PSA level: impact on Gleason score for nonpalpable lesions.
abstract: OBJECTIVE
  To compare results of color Doppler-guided ultrasonography (CDUS) versus those of systematic biopsies in 591 patients with an elevated serum PSA level and to correlate them with digital rectal examination (DRE) findings.
  
  
  METHODS
  Biopsies were directed into hypervascularized (CDUS+) or hypovascularized (CDUS-) hypoechoic peripheral zone nodules (443 cases). When transrectal ultrasound (TRUS) was normal (148 cases), biopsies were directed into hypervascular area. Six additional posterior biopsies were also performed in every patient, together with four anterior biopsies in 117 patients with normal DRE and prostate weight above 40 g.
  
  
  RESULTS
  Biopsies were positive in 339 patients (57%). Positive biopsy rate (PBR) of directed biopsies was 84% in hypervascular abnormalities (264 of 316) and 17% in hypovascular nodules (23 of 134) (P < 0.001). PBR of combined biopsies was 84% in CDUS+ patients (266 of 316) and 26% in CDUS- patients (73 of 275) (P < 0.001). Comparison of TRUS and CDUS showed a sensitivity of 0.9 and 0.78, respectively, and a specificity of 0.46 and 0.8, respectively. Of the 131 patients with a PSA level between 4 and 10 ng/mL and a normal DRE, PBR was 59% (22 of 37) when CDUS was positive and 11% (10 of 94) when it was negative, regardless of TRUS abnormalities (P < 0.001). Nonpalpable cancers with a negative CDUS showed a significantly (P < 0.001) lower Gleason score (5.5 +/- 0.9) than that of CDUS+ cancer (6.5 +/- 1.1). Eleven cancers were diagnosed by only anterior positive biopsies. All of them had a negative CDUS and a PSA level above 10 ng/mL.
  
  
  CONCLUSIONS
  CDUS does not modify prostate biopsy policy except in patients with negative CDUS, normal DRE, and PSA level between 4 and 10 ng/mL, where deferment of biopsy can be advocated. Anterior biopsies are only useful in patients with a PSA level above 10 ng/mL and a negative CDUS.
authors.affiliation: Service de Radiologie, Hôpital Necker, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Cornud
authors.forename: X
authors.initials: X
authors.lastname: Belin
authors.forename: D
authors.initials: D
authors.lastname: Piron
authors.forename: Y
authors.initials: Y
authors.lastname: Chrétien
authors.forename: T
authors.initials: T
authors.lastname: Flam
authors.forename: J M
authors.initials: JM
authors.lastname: Casanova
authors.forename: O
authors.initials: O
authors.lastname: Hélénon
authors.forename: A
authors.initials: A
authors.lastname: Méjean
authors.forename: N
authors.initials: N
authors.lastname: Thiounn
authors.forename: J F
authors.initials: JF
authors.lastname: Moreau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D010173:Palpation; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color
chemical_list: D017430:Prostate-Specific Antigen