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Three-dimensional power Doppler transrectal ultrasound: value in prediction of prostate cancer aggressiveness

Objective The aim of the study was to evaluate the role of three-dimensional power Doppler transrectal ultrasound in the diagnosis and prediction of aggressiveness of prostate cancer. Materials and methods A total of 93 patients were included in the study; all patients had abnormal digital rectal examination or high serum prostate-specific antigen or both. All patients underwent two-dimensional transrectal ultrasound (2D-TRUS), three-dimensional grey-scale transrectal ultrasound (3D-GS TRUS), and three-dimensional power Doppler sonography (3D-PDS). Vascular distribution patterns were evaluated according to the following grading system: I, regular and strip-shaped flow distribution in the peripheral zone (PZ) and/or transitional zone; II, asymmetric abundant flow with vascular disorganization in the PZ; and III, diffusely increased flow with vascular disorganization in the PZ and transitional zone. Grades II and III were regarded as abnormal, and grade I was considered to be normal. Target biopsies were obtained together with 12 core systematic biopsies. Pathological results were correlated with the imaging data. Results Fifty-six patients had prostate cancer, and 37 patients had no evidence of malignant prostatic disease. 3D-PDS had sensitivity of 76.6%, specificity 78.4%, positive predictive value of 84.3%, negative predictive value of 69%, and overall accuracy of 77.4% in differentiation between benign and malignant prostate. The vascular pattern correlated well with serum prostate-specific antigen, Gleason score, presence of metastasis, and local infiltration. Conclusion 3D-PDS improves accuracy of detection, local staging, and prediction of biological behavior of prostate cancer patients compared with 2D-TRUS and 3D-TRUS.