The Transrectal Ultrasonic Manifestations And It's Molecular Biological Basis In Invasive Prostate Cancer

Objectives:Manifestations of transrectal ultrasound (TRUS) and pathology and molecular biology characteristics in different clinical stages were analyzed to evaluate the value of the TRUS in diagnosis of invasive prostate cancer.Methods:74 prostate cancers were selected from January 2006 to January 2009, and TRUS and transrectal ultrasound guided needle biopsy of the prostate were performed in all cases. According to the Whitmore-Jewett clinical staging system, all cases were divided into A+B stage (none invasive groups) and C+D stage (invasive groups).A retrospective analysis of ultrasound was performed and the size, morphous, border and echogenic of tumors were recorded. The peak velocity in systolic (Vs), resistant index and pulsatility index were measured. All data of ultrasound were compared between two clinical stage groups. According to the manifestations in CDFI, the flow of tumors were classified to four grades, and the relationship between clinical stages and CDFI grades were analyzed.According to Gleason score system, all histological specimen were analyzed and classified to middle-well differentiated and poorly different- tiated. The difference between two clinical stage groups were compared in pathohistology. And immunohistochemical analysis in MVD, VEGF, MMP- 2 and MMP-9 were compared between different clinical stage groups too.Results1. 74 cases of prostate cancer were classified into three types by echo pattern: focal nodular type, nodule-infiltrative type and diffuse infiltrative type. Major of A+B stages were showed as focal nodular type (30 cases, 75%), and most of C+D stages were shown as infiltrative types (nodule- infiltrative type and diffuse infiltrative type). There was a significant difference between two groups ( P <0.01). Compared with A+B stages, flow velocity of C+D stages were much higher (P<0.05), but PI and RI had no significant difference between both groups. The flow grades were increased with clinical stages, there was a positive correlation between clinical stages and flow grades ( r =0.297, P=0.010).2. Different of pathohistology were compared between two clinical stage groups, there were 82.5 percentage of A+B stages were middle to well differentiated (33 cases), and most of C+D stages were poorly differentiated (31 cases, 91.2%). There was a significant difference between two groups ( P <0.01).3. Compared between two clinical stage groups, MVD and VEGF expression in C+D stages were higher then A+B stages (P<0.05) and MMP-2 and MMP-9 expression in C+D stages were higher then A+B stages too (P<0.05).Conclusions1. There was a significant difference between invasive prostate cancer and none invasive prostate cancer in characteristics of ultrasonic mani- festations. TURS and CDFI may be helpful in detection of invasive prostate cancer, elevate the level of early diagnosis in prostate cancer, and may have important value in prognosis for prostate cancer.2. Due to the different grades in pathology, the invasive prostate cancer had much higher than none invasive prostate cancer in degree of malignancy and had a worse prognosis.3. The invasive prostate cancer had a higher metastasis ability because of a higher ability in vascularization, more extensive in new vessels distribution and more severity damage in basal membrane, which confirmed by molecular biological analysis. These factors maybe the reason of differ- rence in ultrasonic manifestations between two clinical stage groups and maybe the molecular biological basis in manifestations of TRUS.