Assessment of microvascular flow by Doppler in prostate biopsy: correlation with the Gleason score

To determine whether the degree of microvascular flow on Doppler ultrasound correlates with the aggressiveness of prostate cancer, as defined by the Gleason score.

This was a prospective cohort study including 88 patients evaluated between November 2023 and July 2024. We included men between 48 and 85 years of age with a prostate-specific antigen (PSA) level between 0.3 ng/mL and 21.0 ng/mL and an imaging finding with Prostate Imaging-Reporting and Data System (PI-RADS) category between 2 and 5. Patients with indeterminate biopsy results were excluded, as were those for whom PSA values were missing, those who did not undergo microvascular Doppler assessment, and those previously diagnosed with prostate cancer. In each case, we performed systematic 10-core transrectal biopsy, guided by 1.5-T magnetic resonance imaging-ultrasound fusion, as well as performing Doppler ultrasound with microvascular flow imaging. Vascularization was qualitatively assessed and categorized as absent/minimal, moderate, or marked. The Gleason score was classified as clinically significant (≥ 7) or not (≤ 6)..

A significant association was found between the degree of microvascular flow and the Gleason score (p = 0.0384). Spearman's correlation was moderate (r = 0.377), and Kendall's tau was 0.300, indicating a positive relationship between higher microvascular flow and greater tumor aggressiveness.

Microvascular Doppler shows potential as a complementary tool in prostate biopsy, enabling more precise targeting of regions with increased vascularity, which might be associated with greater tumor aggressiveness.