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Genitourinary Imaging |
1 From the Department of Radiology (E.K., M.A.B.) and the Radiology Fellowship Program (H.M.F., M.B.), Boston University School of Medicine, 88 E Newton St, Boston, MA 02118. Received July 5, 2000; revision requested August 16; final revision received March 29, 2001; accepted March 29. Address correspondence to E.K. (e-mail: ewa.kuligowska@bmc.org).
PURPOSE: To determine the accuracy of detecting prostate cancer by using (a) gray-scale and color Doppler transrectal ultrasonography (US), (b) serum and excess prostate-specific antigen (PSA) levels, and (c) targeted and sextant transrectal US-guided biopsy. The relationship between US–detected neovascularity and tumor biologic activity was also evaluated.
MATERIALS AND METHODS: Between 1995 and 1999, 544 patients with elevated PSA levels and/or abnormal digital rectal examination underwent transrectal US-guided sextant biopsy and targeted biopsy of US abnormalities. Sensitivity, specificity, and accuracy of gray-scale US, color Doppler US, targeted biopsy, and PSA and excess PSA were calculated.
RESULTS: Gray-scale US depicted 78 (41.1%) of 190 cancers, whereas color Doppler US depicted 30 (15.8%) additional cancers. Targeted biopsy was used to detect 108 (56.8%) cancers, whereas sextant biopsy was used to detect 82 (43.2%) additional cancers. Although US-visible cancers had a higher Gleason grade than did cancers discovered at sextant biopsy (P < .05), 25 of the 66 cancers identified with sextant biopsy alone were Gleason grade 6 or higher. Color Doppler US–depicted hypervascularity correlated with biologically aggressive tumors. Excess PSA was normal in 58 (30.5%) cancers, with an accuracy of 67.3%, resulting in better prediction of prostate tumors than with serum PSA level alone.
CONCLUSION: Gray-scale transrectal US, even coupled with color Doppler US, is inadequate for prostate carcinoma screening; therefore, targeted biopsy should always be accompanied by complete sextant biopsy sampling.
Index terms: Genitourinary system, abnormalities, 844.32 • Prostate, biopsy, 844.1261, 844.12985 • Prostate, US, 844.12983, 844.12985, 844.12989
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