Contrast-enhanced transrectal ultrasound can reduce collection of unnecessary biopsies when diagnosing prostate cancer and is predictive of biochemical recurrence following a radical prostatectomy in patients with localized prostate cancer.

BACKGROUND: To investigate the value of using contrast-enhanced transrectal ultrasound (CETRUS) to reduce unnecessary collection of biopsies during prostate cancer diagnosis and its utility in predicting biochemical recurrence in patients with localized prostate cancer. METHODS: This was a prospective study of suspected prostate cancer patients who were evaluated with CETRUS followed by a prostate biopsy. Prostate blood flow via CETRUS was graded using a 5-point scale. The relationship between CETRUS score and biopsy outcome was then analyzed for all patients; univariate and multi-variate analyses were used to determine the probable prognostic factors for biochemical recurrence in patients with localized prostate cancer that underwent a radical prostatectomy. RESULTS: A total of 347 patients were enrolled in the study. Prostate cancer was found in 164 patients. A significant positive correlation (r = 0.69, p < 0.001) was found between CETRUS scores and prostate cancer incidence. Using CETRUS scores ≥2 as the threshold for when to biopsy could have safely reduced the number of biopsies taken overall by 12.1% (42/347) and spared 23.0% (42/183) of patients from undergoing an unnecessary biopsy. 77 patients with localized prostate cancer underwent a radical prostatectomy. The median follow-up time was 30 months (range: 8-56 months) and 17 of these 77 patients exhibited biochemical recurrence during the follow-up period. 3-year biochemical recurrence-free survival rates were 86% for patients with low CETRUS scores (≤ 3) and 59% for patients with high scores (> 3; p = 0.015). Multivariate Cox regression analysis indicated that CETRUS score was an independent predictor of biochemical recurrence (HR: 7.02; 95% CI: 2.00-24.69; p = 0.002). CONCLUSIONS: CETRUS scores may be a useful tool for reducing the collection unnecessary biopsy samples during prostate cancer diagnosis and are predictive of biochemical recurrence in patients with localized prostate cancer following a radical prostatectomy.

Value of flaccid penile ultrasound in screening for arteriogenic impotence: a preliminary prospective study.

BACKGROUND: This prospective study is to evaluate the potential value of sonographic measurements in the flaccid penis for the screening of arteriogenic impotence. METHODS: A consecutive series of 260 Chinese males consulting for sexual dysfunction and 54 controls underwent sonographic examination. The sonographic parameters were correlated with the clinical gold standards, including the international index of erectile function (IIEF) and penile erectile hardness grading scale (EHGS). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating characteristic curve (AUROC) of flaccid peak systolic velocity (PSV) in predicting patients with normal function were analyzed. RESULTS: The mean cavernous PSV of both sides in the patients with sexual dysfunction ranged from 7.76 to 11.12 cm/sec with a stepwise increase in IIEF and EHGS grading scale (P < .05). The cutoff value of flaccid PSV for the differential diagnosis of grade 4 of IIEF-5 or EHGS was 8.20-8.90 cm/sec, with an AUROC of 0.657-0.724, specificity of 82.96-86.84% and PPV of 95.20-96.60%, respectively. CONCLUSIONS: This simple flaccid PSV measurement is a specific tool for screening arteriogenic impotence.

The value of contrast-enhanced transrectal ultrasound in predicting the nature of prostate diseases and the Gleason score of prostate cancer by a subjective blood flow grading scale.

OBJECTIVES: To investigate the value of contrast-enhanced transrectal ultrasound (CETRUS) in predicting the nature of prostate diseases and prostate cancer Gleason score. METHODS: 106 patients suspected of prostate cancer were evaluated with CETRUS followed by systematic biopsy. Prostate blood flow of CETRUS was graded using a subjective 5-point scale. The relationships between ultrasound findings and biopsy outcomes, as well as prostate cancer Gleason score were analyzed. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic performance of CETRUS. RESULTS: Biopsy revealed prostate cancer in 43 of 106 patients. The proportions of malignant histology in the groups with CETRUS scores of 1-5 were 0% (0/10), 8.3% (2/24), 31.7% (13/41), 88.9% (16/18) and 92.3% (12/13), respectively. The rate of prostate cancer with a Gleason score ≥7 in the groups with a CETRUS score of 2-5 were 0% (0/2), 15.4% (2/13), 37.5% (6/16) and 91.7% (11/12), respectively. The blood flow grading scale correlated with pathological outcomes and Gleason score significantly (r = 0.66, p < 0.001; and r = 0.61, p < 0.001, respectively). ROC analysis showed the area under the ROC curve to be 0.87. CONCLUSIONS: CETRUS-based blood flow grading scale is a reliable tool for predicting the pathological outcome of prostate diseases and prostate cancer Gleason score noninvasively.