Significant changes in transrectal ultrasonic measurements of the prostate in relation to the degree of rectal wall distension.

The present study was conducted to reveal the possible changes in transrectal ultrasonic measurements of the prostate in relation to the degree of rectal wall distension. When analyzed together for 51 men, all measurements but area changed statistically significantly as the rectal wall was distended by a balloon covering a probe. Ultrasonic measurements concerning the prostatic shape changed more remarkably than those concerning its size. More importantly, changes in ultrasonic measurements were much more remarkable in patients with a healthy prostate than in those with an advanced BPH. These results suggest that possible changes in prostatic shape with the rectal wall distension has to be taken into account when evaluating transrectal prostatic ultrasonograms in terms of changes in shape, especially in patients with a healthy prostate. This is also the case when the diagnosis of BPH is made based on the change in shape, such as presumed circle area ratio, which is a parameter representing the roundness of the horizontal sonogram of the prostate.

[The role of power Doppler-guided prostatic biopsy in the diagnosis of prostate cancer].

Between March 1997 and December 1998, a total of 170 cases with an abnormal serum prostate specific antigen (PSA) level (range: 4.1-200, mean: 20.5 +/- 31.0) were chosen for this study. Following the evaluation of the prostate using power Doppler imaging (PDI) with a 7.5 MHz transrectal probe, the hypervascular lesion (HVL) was biopsied transperineally under PDI real-time guidance. Thereafter, when gray-scale transrectal sonography revealed a hypoechoic lesion, additional samples were taken from them. Finally, sextant systematic biopsy was performed in all cases. Prostatic biopsy was positive for cancer in 41 cases (24%). The positive biopsy rate was 59% (40/68) in cases with HVL, compared to 1% (1/102) in cases with no HVL (p < 0.0001). In 107 patients with serum PSA 4.1 to 10.0 ng/ml, biopsy was positive in 13 cases (12%). The positive biopsy rate was 38% (12/32) in cases with HVL, compared to 1% (1/75) in cases with no HVL (p < 0.0001). These results imply that HVL represents the neovascularity or increased perfusion of blood in the cancer lesion. Power Doppler-guided prostatic biopsy could be promising as a new biopsy technique in patients with abnormal PSA levels including moderately elevated PSA levels (4.1-10.0 ng/ml).

[Renal angiomyolipoma with marked extrarenal development: a case report].

A 28-year-old female complained of minimal fever elevation. Computed tomography (CT) revealed a left renal tumor of 10 cm in diameter. Ultrasonogram and CT, magnetic resonance imaging and angiography suggested a renal angiomyolipoma (AML) with marked extrarenal development. Partial nephrectomy was performed using a microwave tissue coagulater without clamping of the renal artery. The tumor weight was 800 g and the pathological diagnosis was AML. The management of large AML is reviewed in the literature. Nephron sparing surgery should be performed even in patients who have a larger tumor with extrarenal development.

[Predictability of Gleason score and reduction time (tau) of prostatic volume after castration for the prognosis of prostatic cancer].

PURPOSE: The efficacy of the reduction time (tau) after castration as a prognostic factor was examined by comparing to Gleason score. MATERIALS AND METHODS: The change of prostatic volume after castration was observed from the castration to 3 months after in 24 cases of prostatic cancer. Prostatic volume was examined by transrectal ultrasonography of the prostate. Survival curves was calculated by Kaplan-Meier method. Differences among survival curves were analyzed using Cox-Mantel test. RESULTS: tau had a close relationship to the prognosis of each case (Wilcoxon test: p < 0.05, Cox-Mantel test: p < 0.05). Gleason score had a weak relationship to prognosis (Wilcoxon test: N. S., Cox-Mantel test: p < 0.05). CONCLUSIONS: tau was efficient as prognostic factor compared to Gleason score.

Possible use of transrectal power Doppler imaging as an indicator of microvascular density of prostate cancer.

OBJECTIVES: To reveal the possible use of transrectal power Doppler imaging (PDI) of the prostate in the assessment of the microvascular density (MVD) of cancer lesions. METHODS: In 22 patients with clinically organ-confined prostate cancer, PDI was performed before radical prostatectomy and the degree of vascularity of the cancer lesions as evaluated by PDI was compared with the MVD determined on the surgical specimens. The vascularity by PDI of each cancer lesion was graded on a scale of DS0 to DS2, according to the degree of Doppler signal accumulation. MVD was obtained using factor VIII immunohistochemistry. RESULTS: The vascularity of the PDI of 46 cancer lesions categorized 23 (50%), 10 (22%), and 13 (28%) cancer lesions as DS0, DS1, and DS2, respectively. Significant differences were found in the MVD between DS0 (46.6 +/- 26.8) and DS2 (89.0 +/- 18.1, P <0.005) lesions and between DS1 (50.9 +/- 25.4) and DS2 (P <0.001) lesions. The MVD of 30 cancer lesions in 13 patients without neoadjuvant therapy was significantly higher than that of the 16 lesions in 9 patients with therapy (70.2 +/- 28.2 versus 39.5 +/- 23.9, P <0.001). In the 13 patients without neoadjuvant therapy, the MVD of the DS2 lesions (89.1 +/- 18.9) was significantly higher than that of the DS0 lesions (59.3 +/- 32.5, P <0.01) and DS1 lesions (55.9 +/- 20.9, P <0.005). CONCLUSIONS: The semiquantitative assessment of Doppler flow signals using PDI appears to be of clinical value as an indicator of MVD.

Transrectal power Doppler imaging in the detection of prostate cancer.

OBJECTIVES: To evaluate the clinical utility of transrectal power Doppler imaging (PDI) of the prostate for detecting prostate cancer in patients with abnormally high serum levels of prostate specific antigen (PSA). PATIENTS AND METHODS: Patients (107) with abnormally high serum PSA levels were assessed using a digital rectal examination (DRE), transrectal ultrasonography (TRUS) and PDI. Any hypervascular lesion on PDI was graded on a scale of 0-3, where grade 1-3 was considered positive and grade 0 negative. Patients were then diagnosed by prostatic needle biopsy and the results compared with the other detection methods. RESULTS: Needle biopsy confirmed prostate cancer in 41 (24%) of the 170 patients. PDI was positive in 68, of whom 40 (59%) had prostate cancer; all those but one having prostate cancer were positive on PDI. Thus, PDI had a high sensitivity of 98% (40/41) and a negative predictive value of 99% (101/102). PDI could have saved a significant number of patients from undergoing unnecessary biopsies, compared with DRE and TRUS (P < 0.001). CONCLUSION: The use of PDI in detecting prostate cancer might reduce the number of unnecessary needle biopsies of the prostate in patients with abnormally high serum PSA levels.