The Clinical Study On Transrectal Power Doppler Ultrasonography-direted Prostate Biopsy

Objective: To evaluate the clinical application of transrectal power Doppler ultrasonography and power Doppler ultrasonography-directed prostate biopsy.Materials and Methods: A total of 54 men (mean age 68.96 years, range 41 to 81) with abnormal digital rectal examination(DRE) and(or)serum prostate specific antigen(PSA) levels of greater than 4.0 ng/mL and (or) abnormal—node checked by ultrasound were performed the transrectal ultrasound(TRUS) guided systematic prostate biopsy.The patients underwent gray-scale TRUS and transrectal power Doppler ultrasonography (PDU) of the entire gland before biopsy . The size and vascularity of the prostate were analyzed, Hypoechoic lesions in the peripheral zone on gray-scale TRUS were considered abnormal. All PDU images were then prospectively analyzed, and the vascularity was judged according to the following grading system (0 to 3). Grades 1 to 3 were considered positive and grade 0 negative. Two-core biopsies were taken from each hypoechoic and/or PDU-positive site, followed by a systematic six-core biopsy (four samples from the peripheral zone and two from the transition zone). Patients without any digitally abnormal, hypoechoic, and PDU-positive lesions underwent the six-core biopsy only. The tissue samples obtained from each site were submitted separately for pathologic analysis. The comparison and analysis for these clinical involved the distribution of PDU grade, the sensitivity ,specificity, positive predictive value, negative predictive value , accuracy of the three tests (gray-scale TRUS,PDU, gray-scale and PDU TRUS) and the prostate cancer detection rate of the three different protocols (gray-scale TRUS-targeted ,PDU-targeted and two of targeds biopsy plus systematic six-core transrectal biopsy protocols). Between August 2006 and January 2007,a total of 50 patients suspected of prostate cancer underwent 12 core transrectal ultrasound guided needle biopsy,comprising sextant biopsies and three biopsies in each lateral peripheral zone. The sensitivity of the three different protocols (gray-scale TRUS-targeted ,PDU-targeted and two of targeds biopsy plus systematic six-core transrectal biopsy protocols) was analyzed and compared with a 12 core transrectal ultrasound guided needle biopsy protocol.Results: 1.The positive rate of prostate biopsy was 57.4%(31/54). The pathologic study proved 20 BPH, 31 PCA, 1 doubtful PCA, 1 tumor of prostate, 1 carcinoma of bladder. Severe complications were occurred among the patients who underwent transrectal ultrasound guided biopsies of the prostate. 2.Total 31 patients were found abnormal echogenicityon gray- scale scanning, prostatic cancer in 22 cases, benign prostatehyperplasia (BPH) in 9 cases. 3.The sensitivity, specificity and positive predictive value was 71 %,61 % and 61 % respectively.37 patients were detected abnormal flow area on power Doppler scanning, prostatic cancer in 23 cases, (two of them were nothing findings on gray- scale image),BPH in 11 cases. The sensitivity, specificity and positive predictive value was 74 %, 39 % and 62 % respectively. The distribution of PDU grade was:3 cases with PDU grade 3,23 cases with PDU grade 2 and 14 cases with PDU grade 1. No significant correlation was found between the Gleason score and PDU grade. 4.The mean Gleason score of the PDU- targeted biopsy and the gray-scale-targeted biopsy was 6.96,5.56 respectively. The sensitivity of the three of the three different protocols (gray-scale TRUS-targeted ,PDU-targeted and combined use of these methods targeds biopsy plus systematic six-core transrectal biopsy protocols) was 53.7%,53.7%,57.4% respectively. Prostate cancers were detected in 27 of 50(54.0%)patients with 12 core transrectal biopsy protocol. The sensitivity of three different protocols (gray-scale TRUS-targeted ,PDU-targeted and combined use of these methods targeds biopsy plus systematic six-core transrectal biopsy protocols) was equivalent to that of the 12 core transrectal biopsy (p>0.5).Conclusions: 1.PDU can improve the cancer detection sensitivity,and PDU-directed biopsy at the site correctly detected Gleason score is significantly higher.2. PDU-directed biopsy does not appear to identify prostate cancer , and the sensitivity of combined use of these methods was significantly higher.3. The biopsy protocol that combined use of PDI and gray-scale TRUS-targeted plus systematic six-core transrectal biopsy should be the preferred strategy in early detection of prostate cancer.