Utilidad de la ecografía transrectal con Doppler color en el diagnóstico del cancer de próstata. Estudio de 101 casos

Abstract

ObjectiveTo determine the value of color Doppler ultrasound in the detection of prostate cancer. To relate asymmetries in vascularization with the results of directed biopsy. Patients and methodsBetween May and November 2000, we studied 101 patients suspected of having prostate cancer. The selection criteria were a prostate-specific antigen level of over 3 ng/ml, suspicious digital rectal examination or both.The volume, capsule and internal architecture were assessed, focusing on nodules, suspicious hypoechoic areas and asymmetric color intensity.Sextant biopsies were carried out with an 18-gauge needle and samples were also taken of the areas of increased color intensity. ResultsThe mean patient age was 64.1 ± 7.89 years. Cancer was detected in 25 patients (24.8%): 22 cases of adenocarcinoma (21.8%) and 3 cases of intraepithelial neoplasia (PIN). In 48 patients (47.5%), the diagnosis was benign hyperplasia and 26 (25.7%) presented chronic prostatitis. Two patients were diagnosed as having glandular atrophy.Digital rectal examination was suspicious in 26 cases and was considered normal in the remaining 75. The presence of malignant lesions was confirmed in 14 of the former 26 patients, for a sensitivity of 53.9%, a specificity of 85.9%, a positive predictive value of 53.9% and a negative predictive value of 85.9%.Transrectal ultrasound (TRUS) was described as suggestive of benignity in 34 patients, 5 of whom presented carcinomas. The study revealed some anomaly suggestive of malignancy in 67 cases; carcinomas were discovered i 20 of them (p = 0.9). Thus, in our series, TRUS showed a sensitivity of 80%, a specificity of 38.2%, a positive predictive value of 29.9% and a negative predictive value of 85.3%.Fifty-three patients presented asymmetries in color intensity. In this group, biopsy revealed 14 cases of adenocarcinoma, 1 case of highgrade PIN, 27 cases of benign hypertrophy and 11 of chronic prostatitis.Asymmetry was observed in 15 of the 25 cases of cancer. 13 hypervascular and 2 hypovascular lesions. Vascular asymmetries were not detected in the remaining 10 patients. ConclusionsColor Doppler ultrasound does not obviate the need for prostate biopsy in patients suspected of having cancer. It can be of aid by revealing suspicious areas for biopsy.A color Doppler signal of increrased intensity is not definitive in the diagnosis of cancer. In our study, prostate cancer was associated with increased vascular flow in 52% of cases.Since in cases of confirmed neoplasia, an increase in vascularization was associated with a higher Gleason score, we recommend that biopsy specimens be obtained from areas i which the signal is most intense to determine the highest Gleaseon score.