PURPOSE: To evaluate the risk of low-risk prostate cancer or prostate cancer that may benefit from surveillance in patients with a PSA level less than 10ng/ml, a normal digital rectal examination (DRE) and a transrectal power Doppler sonography (PDS) without anomaly.
PATIENTS AND METHODS: Two hundred and forty-three consecutive patients with a PSA level less than 10ng/ml and a DRE without anomaly had PDS-guided biopsies: 12 to 15 samples were systematically taken and echo-guided in the suspect areas. The PDS results were rated from 1 to 4: 1: normal, 2: slightly hypoechogenic avascular area in which the hypo-echogenicity disappears after compression by probe, 3: hypoechogenic avascular area, 4: hypoechogenic vascularised area with power Doppler sonography. Patients rated 3 or 4 were considered to be pathological. D'Amico's criteria were used to assess the risk of a biological recurrence after treatment and those of Dall'Era were used to select the patients that could benefit from active surveillance (AS). The PDS was considered to be a true positive if at least one biopsy was positive in the same sextant as the suspect image.
RESULTS: In a prospective manner, 106 cancers were diagnosed that could be qualified as low-risk in 84% of the cases (89% with a normal PDS and 79% with an abnormal PDS). Sixty-nine percent of the cases could be subject to AS (86% of the normal PDS cases and 47% of the abnormal PDS cases; P< 0.001). The PDS was normal in 159 of the 243 patients (65%). With a normal PDS, there was a 96% probability of not having a high-risk cancer. With an abnormal PDS, at least one biopsy was positive in 57% of the cases and the probability of having a significant cancer was 30% according to the Dall'Era criteria. A significant reduction was noted with a normal PDS, to 36% and 5%, respectively (VPN=95%) (P=0.015).
CONCLUSION: A normal PDS in patients presenting a PSA level less than 10ng/ml and a DRE without anomaly may be used to put off the indication for a biopsy in order to reduce their number as well as the risks of overtreatment for a latent cancer.
Written by:
Sauvain JL, Sauvain E, Rohmer P, Louis D, Nader N, Papavero R, Bremon JM, Jehl J. Are you the author?
Centre d'Imagerie Médicale, 6, passage Jules-Didier, 70000 Vesoul, France.
Reference: Diagn Interv Imaging. 2012 Dec 1. pii: S2211-5684(12)00303-8.
doi: 10.1016/j.diii.2012.09.003
PubMed Abstract
PMID: 23211834
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