Hypoechoic versus hypervascular lesion in the diagnosis of prostatic carcinoma
Objective: The goal of this study was to get a better understanding the role of Power Doppler (PDUS) and conventional Gray Scale transrectal ultrasound (TRUS) in targeting prostatic biopsy in men with high prostate-specific antigen (PSA).
Patients and methods: A prospective comparative study of 100 men, categorized according to PSA level into two groups: Group (A) with a PSA level (4.0–10.0) ng/ml (Gray zone) and Group (B) with PSA >10.0 ng/ml, above Gray zone. Gray Scale scanning was done, followed by Color Doppler and Power Doppler to test the blood flow all over the prostate and suspicious foci. Twelve systematic TRUS-guided core needle biopsies were performed, and additional biopsies of abnormal lesions on Gray Scale TRUS and PD-TRUS. The demographic data, clinical data, imaging results, laboratory investigations, histopathological report and its correlation with pathological results and any complications during or post the procedure estimated.
Results: The age of the Group (A) ranged between 50 and 75 years with a mean
± S.D. of 65.7 ± 6.8 years, while in the Group (B), it ranged between 54 and 84 years with a mean ± S.D. of 69.5 ± 6.3 years. TRUS biopsy revealed prostate cancer in 11 (35.5%) out of 31 cases of the Group (A) and 35 (50.7%) out of 69 cases of the Group (B) (p < 0.003). Thirty out of 39 (76.9%) from Group (B) were hypervascular in PDUS (p < 0.04). PDUS sensitivity, specificity, positive predictive value (PPV) and negative predictive values were 74.5%, 85.7%, 84.4% and 76.4%.