Evaluation of Prostatic Lesions by Transrectal Ultrasonography, Colour Doppler and TRUS-Guided Biopsy

BACKGROUND We wanted to evaluate the role of a transrectal ultrasound (TRUS) guided biopsy and a colour Doppler test in the detection of prostate cancer in patients with increased serum prostate-specific antigen (PSA) levels and / or an abnormal digital rectal examination (DRE). METHODS A total of 30 cases, in the age group of 50 to 80 years and showing increased serum PSA levels (> 4 ng / mL) and / or abnormal DRE, was enrolled. They underwent TRUS evaluation followed by colour Doppler flowmetric studies. A TRUS-guided fine needle aspiration cytology (FNAC) / biopsy was performed in all the cases. The findings were confirmed histopathologically. Data was analysed using the chi-square and Fisher exact test. RESULTS Histopathologically, a total of 11 cases (36.66 %) were malignant. On TRUS, irregular shape, heterogeneous echotexture loss of differentiation between the peripheral and internal zones, and capsular invasion were significantly associated with malignancy. On flowmetry, moderate vascularity and focal asymmetry were significantly associated with malignancy. The combined use of TRUS and colour Doppler flowmetry was found to be 100 % sensitive and 89.5 % specific and had a positive predictive value (PPV) and a negative predictive value (NPV) of 84.6 % and 100 %, respectively. CONCLUSIONS TRUS with colour Doppler ultrasound plays an important role in the detection of prostatic malignancy with high sensitivity as well as specificity. The high negative predictive value, as observed in the present study could avoid unnecessary diagnostic invasive intervention.