The value of power Doppler imaging to predict the histologic components of benign prostatic hyperplasia.
BACKGROUND
The response of symptoms caused by benign prostate hypertrophy (BPH) to alpha blockade is related to the area density of the smooth muscle of the prostate. If this density could be determined by ultrasound examination, ultrasound might be useful in predicting the efficacy of alpha-blocker therapy. In this study, various ultrasonographic parameters obtained by transrectal method (TRUS) were compared with histologically measured components.


METHODS
Before surgery, ultrasonic power Doppler imaging (PDI) of the prostate was performed using a transrectal probe. The volume of total prostate, transition zone (TZ), and the presumed circle area ratio (PCAR) [1,2] were calculated. Pulsatile blood flow was recorded, and the resistive index (RI) was calculated. Based on the serum concentration of total prostate specific antigen (PSA), ratio of PSA to prostate volume (PSAD), and ratio of PSA to TZ (PSAT) were calculated. Prostate tissues were obtained from 26 patients undergoing transurethral resection, suprapubic prostatectomy, or radical cystectomy, and were analyzed by quantitative morphometry. Computer image analysis was used to determine the mean area densities of the smooth muscle (SM), connective tissue (CT), glandular epithelium (GE) and lumen (GL), and vascular lumen (V). Correlations between ultrasonographic parameters and morphometric data were studied.


RESULTS
On microscopic examination, the specimens showed a wide variety, ranging from normal prostate to typical glandular hyperplasia. There was a correlation between RI and the ratios of the four components (SM: r = -0.42 P = 0.034; CT: r = -0.42 P = 0.030; GE: r = 0.42 P = 0.032; GL: r = 0.46 P = 0.018). However, correlations between the other five transrectal parameters and the composition of the prostate were not so clear. This may have been because the blood vessels are compressed within the surgical capsule together with the urethra.


CONCLUSIONS
The present study demonstrates that when RI is calculated by PDI, it can be quite useful for predicting component ratios, thereby making it possible to predict the therapeutic efficacy of alpha-blockers in individual patients.
Hayami
Shinsuke
S
Department of Urology, Hamamatsu University School of Medicine, Japan. s-haya@muc.biglobe.ne.jp
Ushiyama
Tomomi
T
Kurita
Yutaka
Y
Kageyama
Shinji
S
Suzuki
Kazuo
K
Fujita
Kimio
K
D000368:Aged; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011467:Prostate / Q000098:blood supply; D017430:Prostate-Specific Antigen / Q000097:blood; D011470:Prostatic Hyperplasia / Q000000981:diagnostic imaging* / Q000473:pathology; D012039:Regional Blood Flow / Q000502:physiology; D018709:Statistics, Nonparametric; D014463:Ultrasonography
D017430:Prostate-Specific Antigen