[Power Doppler and 3D vascular sonography of intraprostatic blood supply: assessment criteria and value for the diagnostic and clinical staging of prostatic cancer].
OBJECTIVE
To compare the value of Power Doppler Sonography (PDS) and B mode sonography in the diagnosis of prostate cancer and to assess the value of PDS to assess cell differentiation as a function of the degree of blood supply and to specify capsular effraction of the cancer.


METHODS
133 patients, divided into 2 groups, were investigated: one group consisted of 41 patients with no suspicion of cancer (15 control subjects and 26 patients with acute prostatitis) and a second group consisted of 92 patient with suspected cancer (PSA > 4 ng/ml).


METHODS
Power Doppler sonography with 3D reconstruction was used to calculate a graduated blood supply index from 1 to 3 for nodules of the peripheral zone. Three types of blood supply (A: regular avascular capsule, B: irregular avascular capsule, C: vessels crossing the capsule) were described as a function of the presumed stage of cancer (A: intraprostatic, B: undetermined, C: extraprostatic). Comparison with histology was performed on randomized biopsies (92 cases) and radical prostatectomy specimens (21 cases).


RESULTS
A cancer was diagnosed in 57 of the 92 patients (62%) with suspected cancer. The overall sensitivity of PDS in the initial diagnosis of prostatic cancer was 94.7%, and its specificity was 77.1% (versus 93% and 42.8% for sonography alone, respectively). For a prevalence between 0.4 and 0.9, the PPV ranged from 73.4% to 97.4% and the NPV ranged from 95.6% to 62% (p = 0.02). The correlation between tumour blood supply and Gleason score showed that 20/40 tumours (50%) with a Gleason score > or = 7 had a blood supply index of 3 versus 6/17 (35%) of tumours with a Gleason score < 7 (r = 0.283, p = 0.033). The 3 vascular types, A, B, C, were evaluated prospectively in the detection of capsular effraction. Capsular effraction was detected in one of the 8 cases of type A cancer and in 6 of the 8 cases (75%) of type C cancer.


CONCLUSIONS
PDS improves the reliability of sonography in the diagnosis and staging of prostate cancer. There is a correlation between tumour blood supply and Gleason score.
Sauvain
J L
JL
Centre d'Imagerie Médicale, Vesoul, France.
Palascak
P
P
Bourscheid
D
D
Bloqueau
P
P
Bremon
J M
JM
Jung
L
L
Maniere
P
P
D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology*; D015203:Reproducibility of Results; D018608:Ultrasonography, Doppler
Vascularisation intra prostatique en imagerie Doppler puissance et vasculaire 3D: critères d'analyse et intérêt dans l'établissement du diagnostic et du stade évolutif des cancers.