Local Staging of Prostate Cancer Using Three Dimensional (3D) Transrectal Ultrasound Assisted with Power Doppler Capability

• Ashraf Talaat Youssef

  Department of Radiology, Faculty of Medicine, Fayoum University, Egypt

 Introduction: The ability to differentiate between carcinoma confined to the prostate and the extra-capsular extension (ECE) of the tumor is the key point for management. ECE of prostate cancer can lead to failure of radical prostatectomy and every attempt should be made to localize the tumor and assess its extensions preoperatively. The study aimed to evaluate the value of three dimensional (3D) Transrectal ultrasound (TRUS) assisted with power Doppler in local staging of prostate cancer.

Methodology: -3D TRUS assisted with the power Doppler capability was performed for 120 patients were complaining of burning urination, difficult urination or blood in urine, among them 95 patients were subjected to 3D TRUS guided biopsies.

Results: 33 patients showed prostatic carcinomas, 2 patients showed prostatic sarcoma. In patients with proven prostate cancer 3D TRUS showed an estimated sensitivity 85.7% and specificity 90% with a positive predictive value 83.3%, negative predictive value 91.5% and total accuracy 90.9%. 77% of our cancer patients (27/35) showed hypervascularity by power Doppler ultrasonography while 8 patients (23%) showed no abnormal high vascularity. Power Doppler increased the sensitivity of 3D TRUS in the detection of prostate cancer from 85.7% to 88.5% 3D TRUS clearly identified the extra-prostatic spread in 15 out of 18 patients of an estimated sensitivity (83%).

Conclusion: 3D TRUS aided with power Doppler is a valuable tool in local staging of prostate cancer .The expected benefits in local staging of prostate cancer from the combination of 3D TRUS, power Doppler and 3D TRUS guided biopsy as one sitting exam, will be highly promising.

Bill-Axelson A, Holmberg L, Ruutu M, et al. Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 2005; 352(19): 1977-84. https://doi.org/10.1056/NEJMoa043739

Kälkner KM, Wahlgren T, Ryberg M, et al. Clinical outcome in patients with prostate cancer treated with external beam radiotherapy and high dose-rate iridium 192 brachytherapy boost: a 6-year follow-up. Acta Oncol 2007; 46: 909-17. https://doi.org/10.1080/02841860601156140

Gilliland FD Hoffman RM, Hamilton A, Albertsen P, Eley JW, Harlan L, Stanford JL, Hunt WC, Potosky A, Stephenson RA. Predicting extracapsular extension of prostate cancer in men treated with radical prostatectomy: results from the population based prostate cancer outcomes study. J Urol 1999; 162(4): 1341-5. https://doi.org/10.1016/S0022-5347(05)68281-X

D’amico AV, Whittington R, Malkowicz SB. Clinical Utility of the percentage of positive prostate biopsies in defining biochemical outcome after radical prostatectomy for patients with clinically localized prostate cancer. J Clin Oncol 2000; 18: 1164-72.

Wang L, Zhang J, Schwartz LH, et al. Incremental value of multiplanar cross referencing for prostate cancer staging with endorectal MRI. AJR Am J Roentgenol 2007; 188: 99-104. https://doi.org/10.2214/AJR.05.1783

Sala E, Akin O, Moskowitz CS, et al. Endorectal MR imaging in the evaluation of seminal vesicle invasion: diagnostic accuracy and multivariate feature analysis. Radiology 2006; 238: 929-937. https://doi.org/10.1148/radiol.2383050657

Schiebler ML, Yankaskas BC, Tempany C, et al. MR imaging in adenocarcinoma of the prostate: interobserver variation and efficacy for determining stage C disease. AJR Am J Roentgenol 1992; 158: 559-562. https://doi.org/10.2214/ajr.158.3.1738994

Biondetti PR, Lee JK, Ling D, Catalona WJ. Clinical stage B prostate carcinoma: staging with MR imaging. Radiology 1987; 162: 325-329. https://doi.org/10.1148/radiology.162.2.3797644

Rorvik J, Halvorsen OJ, Albrektsen G, Ersland L, Daehlin L, Haukaas S. MRI with an endorectal coil for staging of clinically localized prostate cancer prior to radical prostatectomy. Eur Radiol 1999; 9: 29-34. https://doi.org/10.1007/s003300050622

Aigner F, Pallwein L, Schocke M, Lebovici A, Junker D, Schafer G, et al. Comparison of real-time sonoelastography with T2-weighted endorectal magnetic resonance imaging for prostate cancer detection. J Ultrasound Med 2011; 30: 643. https://doi.org/10.7863/jum.2011.30.5.643

Pallwein L, Mitterberger M, Struve P, Horninger W, Aigner F, Bartsch B, et al. Comparison of sonoelastography guided biopsy with systematic biopsy: impact on prostate cancer detection. Eur Radiol 2007; 17: 2278-85. https://doi.org/10.1007/s00330-007-0606-1

Hull GW, Rabbani F, Abbas F, Wheeler TM, Kattan MW, Scardino PT. Cancer control with radical prostatectomy alone in 1,000 consecutive patients. J Urol 2002; 167: 528-534. https://doi.org/10.1016/S0022-5347(01)69079-7

Ohori M, Kattan MW, Koh H, et al. Predicting the presence and side of extracapsular extension: a nomogram for staging prostate cancer. J Urol 2004; 171: 1844-1849. https://doi.org/10.1097/01.ju.0000121693.05077.3d

Grossfeld GD, Chang JJ, Broering JM, et al. Under staging and under grading in a contemporary series of patients undergoing radical prostatectomy: results from the Cancer of the Prostate Strategic Urologic Research Endeavor database. J Urol 2001; 165: 851-6. https://doi.org/10.1016/S0022-5347(05)66543-3

Parker SL, Tong T, Bolden SL. Cancer statistics. Cancer J Clin 1997; 47: 5. https://doi.org/10.3322/canjclin.47.1.5

Walsh PC. Anatomic radical retropubic prostatectomy. In: Walsh PC, Retik AB, Vaughan ED Jr, Wein AJ, editors. Campbell’s Urology 1998; ed 7. Vol. 3. Philadelphia: pp. 2565-88.

Cooperberg MR, Simko JP, Cowan JE, Reid JE, Djalilvand A, Bhatnagar S, et al. Validation of a cell-cycle progression gene panel to improve risk stratification in a contemporary prostatectomy cohort. J Clin Oncol 2013; 31(11): 1428-34. https://doi.org/10.1200/JCO.2012.46.4396

Pinto PA, Chung PH, Rastinehad AR, Baccala AA, Jr, Kruecker J, Benjamin CJ, et al. Magnetic resonance imaging/ultrasound fusion guided prostate biopsy improves cancer detection following transrectal ultrasound biopsy and correlates with multiparametric magnetic resonance imaging. J Urol 2011; 186: 1281-5. https://doi.org/10.1016/j.juro.2011.05.078

Xu S, Kruecker J, Turkbey B, Glossop N, Singh AK, Choyke P, et al. Real-time MRI-TRUS fusion for guidance of targeted prostate biopsies. Comput Aided Surg 2008; 13: 255. https://doi.org/10.3109/10929080802364645

Jager GJ, Ruijter ET, van de Kaa CA, de la Rosette JJ, Oosterhof GO, Thornbury JR, Barentsz JO. Local staging of prostate cancer with endorectal MR imaging: correlation with histopathology. AJR Am J Roentgenol 1996; 166(4): 845-52. https://doi.org/10.2214/ajr.166.4.8610561

Epstein JI, Partin AW, Potter SR, Walsh PC. Adenocarcinoma of the prostate invading the seminal vesicle: prognostic stratification based on pathologic parameters. Urology 2000; 56: 283-288. https://doi.org/10.1016/S0090-4295(00)00640-3

Padhani AR, Gapinski CJ, Macvicar DA, et al. Dynamic contrast enhanced MRI of prostate cancer: correlation with morphology and tumour stage, histological grade and PSA. Clin Radiol 2000; 55: 99-109. https://doi.org/10.1053/crad.1999.0327

Gilliland FD, Yu KK, Hricak H, Alagappan R, Chernoff DM, Bacchetti P, Zaloudek CJ. Detection of extracapsular extension of prostate carcinoma with endorectal and phased-array coil MR imaging: multivariate feature analysis. Radiology 1997; 202: 697-702. https://doi.org/10.1148/radiology.202.3.9051019

Wang L, Mullerad M, Chen HN, et al. Prostate cancer: incremental value of endorectal MR imaging findings for prediction of extracapsular extension. Radiology 2004; 232: 133-139. https://doi.org/10.1148/radiol.2321031086

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