Does transrectal color Doppler ultrasound improve the diagnosis of prostate cancer?
OBJECTIVE
To prospectively evaluate whether TRUS guided biopsy associated with Color Doppler (CD) imaging improves the detection of PCa.


METHODS
From January 2008 to December 2010, 144 subjects, with an increased PSA value or with a suspect digital rectal examination, were enrolled. Transrectal grey-scale Ultrasound (US) and CD examination were performed in all patients. CD US was considered positive or negative on the basis of the presence or absence of vascular abnormality. Prostate biopsy was performed immediately after grey-scale and Doppler evaluation, with a mean of 10 core-biopsy for each patient as well as a selective biopsy of all US abnormal areas (hypoechoic lesion or CD abnormality areas).


RESULTS
PCa has been detected in 71 (49.3%) patients. 58 of the 71 patients had a hypoechoic area at US scan and 27 had a CD abnormality. The PSA value was < 4 ng/ml in 11 patients (Group 1), in 63 patients PSA ranged between 4 and 10 ng/ml (Group 2) and in 70 patients PSA was greater than 10 ng/ml (Group 3). The detection rate was 36.7, 36.5 and 62.8% respectively. In Group 1 we detected 5 hypoechoic areas and 4 CD abnormal areas. Moreover 6 of 11 patients had a positive DRE. In the Group 2, 20 patients were positive to DRE; we visualized 21 hypoechoic areas and 7 CD abnormality. In the Group 3, 38 patients had a positive DRE, with 32 hypoechoic areas and 16 CD abnormalities found. We obtained 1537 total bioptic cores, 1440 randomly from peripheral gland, 70 from hypoechoic areas and 27 from abnormal CD flow areas. The detection rate was 17.1, 65.7 and 22.2% respectively.


CONCLUSIONS
CD US showed to be a complement to grey-scale imaging of prostate unless insufficiently sensitive to replace the standard systematic 8-12 core random peripherally biopsy. Furthermore it should be associated routinely to TRUS to easily focus suspect areas.
Department of Urology, University of L'Aquila, G. Mazzini Hospital, Teramo, Italy. delrossoa@tiscali.it
Alessandro
A
Del Rosso
Ezio Domenico
ED
Di Pierro
Stefano
S
Masciovecchio
Giuseppe Paradiso
GP
Galatioto
Carlo
C
Vicentini
D000368:Aged; D000465:Algorithms; D014408:Biomarkers, Tumor / Q000097:blood; D001707:Biopsy, Needle; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology*; D012007:Rectum; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color / Q000379:methods; D018084:Ultrasonography, Interventional / Q000379:methods
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen