Role of Color Doppler Transrectal Ultrasonography in Targeting Prostatic biopsy and Detecting Prostate Cancer
Muhammad Hassan AL-agamy Ali;
Abstract
The tools for the detection of prostate cancer (PCa) usuallyconsist of digital rectal examination (DRE), serumprostate specific antigen (PSA) measurement and greyscaleTransRectal UltraSonography (TRUS).
The measurement of PSA enables the detection ofprostate cancer that is still organ confined. However, the specificity of the PSA level is unsatisfactory and thismethod yields no information on the location of thelesion. Although the development of TRUS has improvedthe detection of prostate cancer lesions, the positivepredictive value (PPV) of TRUS is low, despite itsrelatively high sensitivity.
Since these investigationsare limited in terms of sensitivity and positive predictivevalue (PPV), the diagnosis needs to be confirmedusing TRUS guided systematic random biopsies. Theresulting sample error from these untargeted biopsies is acause of many negative biopsies, while significant tumoursare missed or under graded.
Clearly, diagnosis through systematic untargeted biopsiesis far from ideal, and the lack of an adequate imagingtool is a major deficit of the diagnostic pathway.
Consequently,research is prioritized towards finding imagingtechniques that enable replacing systematic untargetedbiopsies by a few targeted biopsies. When a sufficientlyhigh negative predictive value (NPV) is attained, it shouldbe possible to exclude PCa based on imaging alone, eliminatingthe necessity of taking prostate biopsies in everypatient with a suspicion based on DRE or PSA.
In the present study, to evaluate therole of CDU in detecting prostate cancer, we comparedthe diagnostic accuracies of CDU with grey scale TRUS, comparing the results with the prostaticbiopsy pathology results.
We started this study depending on the fact that prostate cancer requires neovessel formation to grow which increases vascularity either in a specific spot in the prostate, peripheral zone, or the whole gland, so we can detect the blood flow within these neovessels using CDU to diagnose prostate cancer and to target needle biopsy.
Aslo it was found that the more the vascularity of the prostate, the more the aggrissivness of prostate cancer, so CDU can also predict the biological behavior of cancer.
According to this study CDU increases specificity and sensitivity of transrectal ultrasound in the diagnosis of cancer prostate and improves accuracy of targetting prostatic needle biopsy which decreases the number of missed cases and provides early diagnosis of cancer.
Based on this study we recommend using CDU scan during performing transrectal ultrasound guided biopsy which is not time consuming and does not require high costs like MRI but it needs good experience.
The measurement of PSA enables the detection ofprostate cancer that is still organ confined. However, the specificity of the PSA level is unsatisfactory and thismethod yields no information on the location of thelesion. Although the development of TRUS has improvedthe detection of prostate cancer lesions, the positivepredictive value (PPV) of TRUS is low, despite itsrelatively high sensitivity.
Since these investigationsare limited in terms of sensitivity and positive predictivevalue (PPV), the diagnosis needs to be confirmedusing TRUS guided systematic random biopsies. Theresulting sample error from these untargeted biopsies is acause of many negative biopsies, while significant tumoursare missed or under graded.
Clearly, diagnosis through systematic untargeted biopsiesis far from ideal, and the lack of an adequate imagingtool is a major deficit of the diagnostic pathway.
Consequently,research is prioritized towards finding imagingtechniques that enable replacing systematic untargetedbiopsies by a few targeted biopsies. When a sufficientlyhigh negative predictive value (NPV) is attained, it shouldbe possible to exclude PCa based on imaging alone, eliminatingthe necessity of taking prostate biopsies in everypatient with a suspicion based on DRE or PSA.
In the present study, to evaluate therole of CDU in detecting prostate cancer, we comparedthe diagnostic accuracies of CDU with grey scale TRUS, comparing the results with the prostaticbiopsy pathology results.
We started this study depending on the fact that prostate cancer requires neovessel formation to grow which increases vascularity either in a specific spot in the prostate, peripheral zone, or the whole gland, so we can detect the blood flow within these neovessels using CDU to diagnose prostate cancer and to target needle biopsy.
Aslo it was found that the more the vascularity of the prostate, the more the aggrissivness of prostate cancer, so CDU can also predict the biological behavior of cancer.
According to this study CDU increases specificity and sensitivity of transrectal ultrasound in the diagnosis of cancer prostate and improves accuracy of targetting prostatic needle biopsy which decreases the number of missed cases and provides early diagnosis of cancer.
Based on this study we recommend using CDU scan during performing transrectal ultrasound guided biopsy which is not time consuming and does not require high costs like MRI but it needs good experience.
Other data
| Title | Role of Color Doppler Transrectal Ultrasonography in Targeting Prostatic biopsy and Detecting Prostate Cancer | Other Titles | دور الموجات فوق الصوتية من خلال الشرج بالدوبلر الملون في استهداف عينة البروستاتا واكتشاف سرطان البروستاتا | Authors | Muhammad Hassan AL-agamy Ali | Issue Date | 2017 |
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