Predictors of prostate carcinoma: accuracy of gray-scale and color Doppler US and serum markers.
OBJECTIVE
To determine the accuracy of detecting prostate cancer by using (a) gray-scale and color Doppler transrectal ultrasonography (US), (b) serum and excess prostate-specific antigen (PSA) levels, and (c) targeted and sextant transrectal US-guided biopsy. The relationship between US-detected neovascularity and tumor biologic activity was also evaluated.


METHODS
Between 1995 and 1999, 544 patients with elevated PSA levels and/or abnormal digital rectal examination underwent transrectal US-guided sextant biopsy and targeted biopsy of US abnormalities. Sensitivity, specificity, and accuracy of gray-scale US, color Doppler US, targeted biopsy, and PSA and excess PSA were calculated.


RESULTS
Gray-scale US depicted 78 (41.1%) of 190 cancers, whereas color Doppler US depicted 30 (15.8%) additional cancers. Targeted biopsy was used to detect 108 (56.8%) cancers, whereas sextant biopsy was used to detect 82 (43.2%) additional cancers. Although US-visible cancers had a higher Gleason grade than did cancers discovered at sextant biopsy (P <.05), 25 of the 66 cancers identified with sextant biopsy alone were Gleason grade 6 or higher. Color Doppler US-depicted hypervascularity correlated with biologically aggressive tumors. Excess PSA was normal in 58 (30.5%) cancers, with an accuracy of 67.3%, resulting in better prediction of prostate tumors than with serum PSA level alone.


CONCLUSIONS
Gray-scale transrectal US, even coupled with color Doppler US, is inadequate for prostate carcinoma screening; therefore, targeted biopsy should always be accompanied by complete sextant biopsy sampling.
Kuligowska
E
E
Department of Radiology, Boston University School of Medicine, 88 E Newton St, Boston, MA 02118, USA. ewa.kuligowska@bmc.org
Barish
M A
MA
Fenlon
H M
HM
Blake
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color
D017430:Prostate-Specific Antigen