title: Doppler spectral waveform parameters at neurovascular bundle vessels in patients with prostate biopsy.
abstract: OBJECTIVE
  There is a need to improve prescreening determination of prostate cancer to better select patients who need biopsy. Such a strategy properly implemented, will decrease the number of negative biopsies for prostate cancer and in turn better balance the risks and morbidity for patients recommended for biopsy. The aim of study is to investigate Doppler spectral waveform parameters of neurovascular bundle (NVB) vessels and determine differences between benign and malignant pathologies.
  
  
  METHODS
  We performed a prospective analysis involving 292 patients who received prostate biopsy for elevated prostate-specific antigen (PSA) values or abnormal digital rectal examination, as well as 174 patients with symptomatic benign prostatic hyperplasia. Doppler spectral waveform (DSW) parameters (peak-systolic velocity [PSV], end-diastolic velocity [EDV], and resistive index [RI]) were measured at bilateral NVB vessels through Doppler transrectal ultrasound at the right lateral decubitus position, compared, and analyzed among patients with benign versus malignant histology for each side.
  
  
  RESULTS
  Overall, both PSV and EDV at malignant sides were significantly higher than those at benign sides, as well as lower RI (all p-values <0.05, unpaired t-test). In subgroup analysis with 93 patients of serum PSA between 10 and 20 ng/mL and 56 patients with one-side malignancy, higher EDV and lower RI were significantly associated with malignancies (all p<0.05). The values of PSV and EDV rather than RI might be influenced by the patients' position and RI by the prostate volume.
  
  
  CONCLUSIONS
  In this study, DSW parameters (mainly EDV and RI) at NVB vessels were significantly associated with prostate cancer, particularly in patients with serum PSA of 10-20 ng/mL. It should be in caution that the patients' position and prostate volume may influence the Doppler signal as demonstrated in the current study. These findings can provide more diagnostic information before prostate biopsy.
authors.affiliation: 1 Department of Urology, College of Medicine and Hospital, National Cheng Kung University , Tainan, Taiwan .
authors.forename: Yuh-Shyan
authors.initials: YS
authors.lastname: Tsai
authors.forename: Yeong-Chin
authors.initials: YC
authors.lastname: Jou
authors.forename: Chia-Hong
authors.initials: CH
authors.lastname: Chen
authors.forename: Chien-Chen
authors.initials: CC
authors.lastname: Chang
authors.forename: Wen-Horng
authors.initials: WH
authors.lastname: Yang
authors.forename: Jan-Li
authors.initials: JL
authors.lastname: Lai
authors.forename: Tzong-Shin
authors.initials: TS
authors.lastname: Tzai
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging* / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011467:Prostate / Q000098:blood supply* / Q000000981:diagnostic imaging; D011471:Prostatic Neoplasms / Q000098:blood supply / Q000175:diagnosis*; D015203:Reproducibility of Results; D018608:Ultrasonography, Doppler / Q000379:methods*