Value of power doppler and 3D vascular sonography as a method for diagnosis and staging of prostate cancer

OBJECTIVES

To compare the value of Power Doppler Sonography (PDS) and B mode sonography in the diagnosis of prostate cancer and to assess the value of PDS to specify capsular effraction of the cancer.

PATIENTS AND METHODS

323 patients were investigated: 41 control subjects allowed the establishment of normal vascular semiology and 282 patients with suspected cancer (PSA >4ng/ml). Power Doppler Sonography with 3D reconstruction was used to describe Power Doppler Sonography features of normal or abnormal vessels. Three types of blood supply(a: regular avascular posterior peripheral margin, b: irregular avascular posterior peripheral margin, c: vessels crossing the posterior peripheral margin) were described as a function of the presumed stage of cancer (a: intraprostatic, b: undetermined, c: extraprostatic). Comparison with histology was performed on random biopsies without Doppler (282 cases) (median PSA level = 15.8ng/ml), on second biopsies indicated with PDS (72 cases), and radical prostatectomy specimens (63 cases).

RESULTS

A cancer was diagnosed in 157 of the 282 patients (55.7%) with suspected cancer. The overall sensitivity of PDS in the initial diagnosis of prostatic cancer was 92.4% and its specificity was 72% (versus 87.9% and 57.6% for sonography alone respectively). The negative predictive value of PDS was elevated to 80.6% (p<0.0001). Targeting area presenting abnormal blood flow in any part of the prostate was useful to detect isoechoic or lesions in patients with first negative biopsy results (in 41 of 72 targeted patients with first negative biopsies with PDS a cancer was diagnosed: 58% of these cancers had less than 3 positive biopsies and 34% only one positive biopsy). The 3 vascular types a, b, c were evaluated prospectively in the detection of capsular effraction. The presence or absence of vessels crossing the capsule to determine an extracapsular extension was a significant sign (p<0.0001). Capsular effraction was detected in 3 of the 27 cases (11%) of type a cancer and in 16 of the 18 cases (87%) of type c cancer.

CONCLUSION

PDS improves the accuracy of echographic imaging in the diagnosis of cancer. Combining first sextant biopsies and targeted areas presenting abnormal blood flow using PDS can increase cancer detection with an optimized number of biopsy cores. The risk of extracapsular involvement can be evaluated by the presence of vessels perforating the capsule.

[Power Doppler and 3D vascular sonography of intraprostatic blood supply: assessment criteria and value for the diagnostic and clinical staging of prostatic cancer]

OBJECTIVES

To compare the value of Power Doppler Sonography (PDS) and B mode sonography in the diagnosis of prostate cancer and to assess the value of PDS to assess cell differentiation as a function of the degree of blood supply and to specify capsular effraction of the cancer.

PATIENTS

133 patients, divided into 2 groups, were investigated: one group consisted of 41 patients with no suspicion of cancer (15 control subjects and 26 patients with acute prostatitis) and a second group consisted of 92 patient with suspected cancer (PSA > 4 ng/ml).

METHODS

Power Doppler sonography with 3D reconstruction was used to calculate a graduated blood supply index from 1 to 3 for nodules of the peripheral zone. Three types of blood supply (A: regular avascular capsule, B: irregular avascular capsule, C: vessels crossing the capsule) were described as a function of the presumed stage of cancer (A: intraprostatic, B: undetermined, C: extraprostatic). Comparison with histology was performed on randomized biopsies (92 cases) and radical prostatectomy specimens (21 cases).

RESULTS

A cancer was diagnosed in 57 of the 92 patients (62%) with suspected cancer. The overall sensitivity of PDS in the initial diagnosis of prostatic cancer was 94.7%, and its specificity was 77.1% (versus 93% and 42.8% for sonography alone, respectively). For a prevalence between 0.4 and 0.9, the PPV ranged from 73.4% to 97.4% and the NPV ranged from 95.6% to 62% (p = 0.02). The correlation between tumour blood supply and Gleason score showed that 20/40 tumours (50%) with a Gleason score > or = 7 had a blood supply index of 3 versus 6/17 (35%) of tumours with a Gleason score < 7 (r = 0.283, p = 0.033). The 3 vascular types, A, B, C, were evaluated prospectively in the detection of capsular effraction. Capsular effraction was detected in one of the 8 cases of type A cancer and in 6 of the 8 cases (75%) of type C cancer.

CONCLUSION

PDS improves the reliability of sonography in the diagnosis and staging of prostate cancer. There is a correlation between tumour blood supply and Gleason score.

[Hematemesis disclosing hemorrhagic fever with renal syndrome]

We report a case of hematemesis as the presenting sign of hemorrhagic fever with renal syndrome. Gastroscopy revealed hemorrhagic gastropathy. Such lesions are a common finding in epidemic nephropathy, the European form of the disease. The occurrence of such lesions could be induced in a direct, cytopathic effect of the virus but seems also to be related to the severity of thrombocytopenia.