CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2018; 02(03): S20-S21
DOI: 10.1055/s-0041-1730699
Abstract

Evaluation of Prostatic Lesions by Transrectal Ultrasound, Color Doppler, and the Histopathological Correlation

Gaurav Katyal
Max Superspeciality Hospital, New Delhi, India
,
Babu Ram Goyal
Max Superspeciality Hospital, New Delhi, India
,
Archana Mathur
Max Superspeciality Hospital, New Delhi, India
,
Ravikumar Patel
Max Superspeciality Hospital, New Delhi, India
› Author Affiliations

Background: Prostate cancer is the most common malignancy in men in the United States, with approximately 192,280 cases diagnosed yearly. Globally too, prostate cancer happens to be the second-most common cancer among males, with annual incidence reaching up to 679,060 cases. The diagnosis and treatment of prostate cancer are very challenging. The current methods of screening for prostate cancer include measuring serum prostate-specific antigen levels (PSA), digital rectal examinations (DREs), and transrectal ultrasound (TRUS). A color Doppler ultrasound, because of its ability to effectively visualize vascular changes, provides a better diagnostic as well as prognostic value. Prostate cancer, in common with many other tumors, shows increased angiogenesis, resulting in increased microvessel density. Increased color Doppler blood flow tends to indicate more aggressive tumors with higher Gleason grades as well as a higher risk of recurrence. Due to the benefits of a color Doppler test, it is gaining popularity as a diagnostic modality for differentiating between various prostatic lesions with a reported benefit over the conventionally used TRUS approach. Methods: The study was carried out on a total of 40 male patients, aged 50–80 years, with serum PSA levels of 4–10 ng/ml in the absence of urinary tract infections, acute urinary retention, acute prostatitis, or recent catheterization and having a hard, enlarged nodular prostate on DRE. The project was approved by the institutional ethics committee. Informed consent was obtained from all the participants. All suspected patients attending the surgical outpatient/inpatient of our institution who fulfilled the inclusion criteria were examined in the left lateral decubitus, knee–chest position, and were subjected to DRE. TRUS with a color Doppler for the detection of prostatic lesion using G. E. LOGIQ 5 PRO ultrasound color Doppler machine (with a TRUS probe [6–10 MHz]). Later, a TRUS-guided biopsy was performed using an 18G biopsy gun to confirm the radiological diagnosis. Results: Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 21.0 (IBM, New York, USA). A Chi-square test and a “t-” test of independent samples were used to compare the data. P < 0.05 indicated a significant association. Diagnostic efficacy was expressed in terms of sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy. The age of patients ranged from 51 to 77 years. The mean age of patients was 63.80 ± 6.76 years. A majority of the patients were <65 years of age (65%); on DRE, a total of 17 (42.5%) patients had induration while 23 (57.5%) had nodular lesions. PSA values ranged from 5.8 to 9.8 ng/ml. Exactly half of the patients had PSA <8 ng/ml; histopathologically, 13 (32.5%) cases were malignant. On TRUS evaluation, a total of 10 (25%) cases were malignant. TRUS findings combined with color Doppler vascularity findings diagnosed malignancy in 15 (37.5%) cases. Conclusion: The findings of the present study showed that TRUS with color Doppler flowmetry can play an important role in the detection of prostate malignancy, with high sensitivity as well as specificity. The high NPV, as observed in the present study, could avoid unnecessary diagnostic invasive intervention. In the present study, TRUS diagnosis established 30 (75%) cases as benign and 10 (25%) cases as malignant, showing the rate of cancer detection to be close to that diagnosed through histopathology. Among different TRUS characteristics, irregular shape, heterogeneous echotexture, loss of differentiation between the peripheral and internal zones, increased mean prostate weight, and capsular invasion were found to be significantly associated with malignancy.



Publication History

Article published online:
11 May 2021

© 2018. The Arab Journal of Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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