Evaluation of power Doppler ultrasonography for prostate biopsy in men with elevated serum prostate specific antigen levels

OBJECTIVE: To evaluate power doppler ultrasonography (PDU)-directed prostate biopsy in patients with elevated serum prostate specific antigen (PSA) levels.
MATERIALS AND METHODS: Men with serum total PSA levels of more than 4 ng/ml undergoing biopsy for the first time were included. Grey-scale transrectal ultrasound (TRUS) and PDU were performed. PDU signal on vascularity accumulation and perfusion characteristics were recorded and graded as normal or abnormal in the peripheral zone of the prostate. Abnormalities were defined on transverse image as radial or arc hypervascularities. A biopsy regime based on Vienna-normogram was performed in all patients.
RESULTS: Overall, prostate adenocarcinoma detection rate was 21.4% and abnormal accumulation on PDU signal was identified in 96.7% of those patients (p = 0.01). PDU directed prostate biopsies were positive in 66.7% of the patients with prostate cancer. The sensitivity, specificity, positive predictive value and negative predictive value of PDU signal alone for prostate cancer detection was 96.7%, 24.5% and 96.4% respectively, and PDU guided biopsies were 66.7%, 24.5%, 19.4% and 73% respectively.
CONCLUSIONS: The high sensitivity and negative predictive value of PDU makes it useful as an aid for TRUS biopsy in selected patient with previous negative biopsies at risk of harbouring prostate cancer.