Prostate biopsies using both gray scale and 3D color flow power doppler ultrasound (3DCFPDU).

Abstract

103 Background: Historically, prostate cancer (CAP) is identified through random biopsies. Experts usually recommend 10-12 core transrectal ultrasound guided biopsies (TRUS). This often leads to sampling errors with missed diagnosis, delayed and repeated biopsies, understaging and finding indolent CAP leading to over treatment. Advances in 3DCFPD imaging suggest that selective biopsies may be superior to standard TRUS biopsies. Methods: 192 consecutive patients were biopsied (Feb. 2012 – July 2014) in the dorso-lithotomy position with local anesthesia. Median number of biopsies per patient = 8; total number of cores = 1,520. Only 3 patients had not been previously biopsied (median previous biopsies = 2). We studied tumor detection rate using combined gray scale and 3DCFPD with direct sampling of specific regions using the transperineal brachytherapy template guided method as a simple outpatient procedure. Inclusion criteria were abnormal DRE, PSA kinetics 0.75ng/mg/yr, PSA >10 and % free PSA <17. PSA density 0.27. Cores were stratified into 4 risk groups: 1) hypoechoic lesion (72 patients, 648 cores); 2) hypervascular lesion (26 patients, 182 cores); 3) hypoechogenic with hypervascular pulsatile vessels synchronous and coinciding with normal cardiac pulse (32 patients, 256 cores); and 4) hypoechogenic with hypervascular non-pulsatile vessels suggesting independent vascular flow consistent with neoplasm (62 patients, 434 cores). Isoechoic regions were not biopsied. Subgroups were analyzed using chi-square, student t-test, and logistic regression. Results: The diagnostic yield associated with Group 4 was statistically significantly higher compared to: 1.) 20% biopsy positive (p <0.5); 2.) 19% biopsy positive (p <0.3); 3.) 55% biopsy positive (p <0.1); 4.) 97% biopsy positive (p <0.1). Only Group 4 revealed a greater number of Gleason 7-10 CAP (p <0.1). Conclusions: Transperineal template guided biopsies with gray scale and 3DCFPD are highly effective and cost effective. This may lead to reducing the number of prostate biopsies performed, better staging and allowing for enhanced detection of serious CAP by targeting the most suspicious lesions. Additional research should study the diagnostic gain with 3DCFPD.