COLOR DOPPLER IMAGING AND TRANSRECTAL SONOGRAPHY OF THE PROSTATIC FOSSA AFTER RADICAL PROSTATECTOMY - EARLY EXPERIENCE

OBJECTIVE. Our objective was to determine if the addition of color Dop pler imaging (CDI) during transrectal sonography can improve the detec tion of residual or recurrent prostatic cancer after radical prostatec tomy. MATERIALS AND METHODS. Thirty patients who had undergone radical prostatectomy for prostatic cancer were evaluated with transrectal so nography and transrectal sonography with CDI. Twenty-three of these 30 patients were evaluated for suspicion of local tumor recurrence. The remaining seven patients were not suspected of harboring recurrent tum or and served as controls. Transrectal sonography and CDI-directed nee dle biopsies of the vesicourethral anastomosis (four-quadrant) and per ianastomotic soft tissues were obtained in the 23 patients suspected o f recurrent tumor. The ability of transrectal sonography to detect loc al tumor recurrence was compared with transrectal sonography with CDI. RESULTS. Fourteen of 23 patients (61%) had positive transrectal sonog raphy or transrectal sonography and CDI-directed biopsies. Transrectal sonography alone detected gray-scale abnormalities in 11 of 23 patien ts (48%), of whom 10 (43%) had positive transrectal sonography-directe d biopsies. CDI during transrectal sonography showed hypervascularity in 12 of 23 patients (52%). Biopsies of these hypervascular regions we re positive in all 12 patients (100%). Hypervascularity was detected i n 10 of 11 (91%) gray-scale abnormalities initially detected with tran srectal sonography alone. CDI during transrectal sonography detected t wo patients with hypervascular areas without associated gray-scale fin dings. Both patients had positive biopsies of their hypervascular site s. Transrectal sonography had a sensitivity and specificity of 71% and 89%, respectively, with positive and negative predictive values of 91 % and 67%, respectively. CDI during transrectal sonography had a sensi tivity and specificity of 86% and 100%, respectively, with positive an d negative predictive values of 100% and 82%, respectively. CONCLUSION . CDI used during transrectal sonography improves the detection of ear ly recurrent or residual prostatic cancer compared with transrectal so nography alone. Although most gray-scale abnormalities that are recurr ent tumor show hypervascularity, CDI can detect additional tumor recur rences not identifiable with transrectal sonography alone.