title: Limiting overdiagnosis of low-risk prostate cancer through an evaluation of the predictive value of transrectal and power Doppler ultrasonography.
abstract: OBJECTIVE
  Overdiagnosis induced by prostate cancer screening makes necessary a better selection of candidate patients for prostate biopsy. The objective of our study is to assess the probability of having a high- or low-risk lesion that could require active surveillance (AS) after biopsies and a normal or abnormal examination, including transrectal and power Doppler ultrasonography (TRUS-PDS).
  
  
  METHODS
  Four hundred and twenty-nine consecutive patients with a PSA level <10 ng/ml and a normal digital rectal examination (DRE) had guided biopsies in a prospective study. We used D'Amico's criteria to assess the risk of a biological recurrence and Dall'Era's criteria to assess possible AS. The TRUS-PDS was considered positive if one biopsy was positive in the same sextant as the suspect image.
  
  
  RESULTS
  One hundred and seventy-seven out of 429 (41 %) T1c cancers were diagnosed; 131 out of 177 (74 %) could be qualified as low risk, and 119 out of 177 (67 %) could require AS. The TRUS-PDS was normal in 285 of 429 patients (66 %). With a normal TRUS-PDS, the probability of not having cancer with a high or intermediate risk was 96 % (negative predictive value). With an abnormal TRUS-PDS, the probability of having a positive biopsy was 59 %, and the probability of having a significant cancer was 30 %, according to the Dall'Era criteria. When TRUS-PDS was normal, these probabilities significantly decreased to 32 and 5 %, respectively (p< 0.01).
  
  
  CONCLUSIONS
  Patients with a PSA level <10 ng/ml, a normal DRE, and a normal TRUS-PDS have a less than 5 % risk of high- or intermediate-risk cancer.
authors.affiliation: Medical Imaging Center, 6 Passage Jules Didier, 70000 Vesoul, France.
authors.forename: Jean Luc
authors.identifier: 0000-0003-0764-1225
authors.initials: JL
authors.lastname: Sauvain
authors.affiliation: Department of Pathology, Hospital Robert-Debré, Reims University Hospital, Rue du Général-Kœnig, 51100 Reims, France.
authors.forename: Elise
authors.initials: E
authors.lastname: Sauvain
authors.affiliation: Medical Imaging Center, 6 Passage Jules Didier, 70000 Vesoul, France.
authors.forename: Roger
authors.initials: R
authors.lastname: Papavero
authors.affiliation: Department of Urology, Saint Martin Hospital, Les Haberges, 70000 Vesoul, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Louis
authors.affiliation: Medical Imaging Center, 6 Passage Jules Didier, 70000 Vesoul, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Rohmer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D051517:Digital Rectal Examination; D005188:False Negative Reactions; D005189:False Positive Reactions; D006801:Humans; D061705:Image-Guided Biopsy; D008297:Male; D000069342:Medical Overuse / Q000517:prevention & control*; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging* / Q000473:pathology; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D012306:Risk; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler / Q000379:methods*
keywords: High-risk cancer; Low risk cancer; Overdiagnosis; Power Doppler sonography; Prostate cancer; Transrectal ultrasound