A more effective TR systematic biopsy of the prostate associated with power doppler ultrasonography (PDU): technical...

It is by now ascertained how PDU improves the effectiveness of systematic biopsy of the prostate. We have attempted to find better technical and imaging methods to optimise results.

We associated echo-biopsy with PDU on 131 patients. 64 patients (48.85%) showed prostate Ca. Their age was between 53 and 84 (av. 71.7) with PSA ranging from 1.14 and 59.7 (r. 9.,55 +/- 11.99 ng/ml). We then tried to locate in each sector areas of altered vascularization.

In 34 cases (53.12%) we found hypo/hyper/iso reflecting areas surrounded by numerous vessels and crossed by one or more vascular branches (usually 2-3). In 8 cases (12.5%) we found hypo/hyper vascular echogenic virtually avascular, i.e. only a small perforating or surrounding branch. In 13 cases (20%) we found an aspecific and often widespread hyper-vascularization not associated to echographically atypical areas, bilateral in 4 cases. In 9 cases (14%) we did not find evident vascular alterations during PDU. Through the correlation of power Doppler ultrasonography images with histology we noticed that the area of altered vascularization was positive to Ca in 38 patients (59.37%) whereas the same was not true in 5 patients (7.8%), and finally in 21 patients (32.8%) the echo-doppler results (12 hypervascular and 9 "normal") was too aspecific to allow any kind of histomorphologic correlation.

There are no pathognomonic patterns detectable through PDU for prostate Ca; although in the light of the above data it is safe to assume the existence of PDU detectable vascular alterations that in a good number of cases are not always neoplastic but prostatic disease which often coincide (about 60%) with cancer. The association of systematic biopsy and PDU helps highlight these areas thereby considerably improving diagnoses.