Study Type – Diagnosis (exploratory cohort)
Level of Evidence 2b
OBJECTIVE
To correlate a subjective blood‐flow rating scale from contrast‐enhanced colour Doppler (CECD) transrectal ultrasonography‐targeted prostate biopsy with the histopathological outcome of the biopsy.
PATIENTS AND METHODS
In all, 760 men with a serum total prostate‐specific antigen (PSA) level of ≥1.25 ng/mL and a free‐to‐total PSA ratio of <18% were included. CECD‐targeted biopsies with five cores were taken only in hypervascular areas of the peripheral zone using a second‐generation ultrasonography contrast agent, followed by a 10‐core systematic biopsy. Prostate blood flow was scored using a subjective 5‐point scale in which 1 indicated ‘benign’, 2 ‘probably benign’, 3 ‘indeterminate’, 4 ‘probably malignant’ and 5 ‘malignant’.
RESULTS
Overall 37% (283 of 760) patients had prostate cancer in the biopsy. All 100 patients with a score of 5 had cancer; 153 had a score of 4, of whom 130 (85%) had cancer and 23 had benign histology (15%); 131 had a score of 3, of whom 34 (26%) had cancer and 97 (74%) had benign histology; 284 had a score of 2, of whom 17 (6%) had cancer and 267 (94%) had benign histology; 92 had a score of 1, of whom two (2%) had cancer and 90 (98%) had benign tissue. Statistical evaluation showed that the subjective blood‐flow rating scale correlated strongly and significantly (r= 0.75, P < 0.01) with the histopathological outcome of the biopsy.
CONCLUSION
The present study shows that a subjective CECD blood‐flow rating scale is a reliable tool to predict the pathological outcome of biopsy cores.