COLOR DOPPLER IMAGING IN PREDICTING THE BIOLOGIC BEHAVIOR OF PROSTATE-CANCER - CORRELATION WITH DISEASE-FREE SURVIVAL

Objectives. We investigated the association of transrectal color Doppl er imaging (CDI) signal detection in localized prostate cancer with bi ologic behavior as assessed by tumor Gleason grade, seminal vesicle in vasion, capsular and margin status, and actuarial biochemical freedom from relapse. Methods, From 1991 to 1996, transrectal ultrasound with CDI and biopsy was performed in 2718 men using a 7.0-MHz probe optimiz ed to detect color-coded blood flow within the gland and along the cap sular margin. Color flow was graded on a scale from 0 to 2+, with 0 an d 1+ representing no detectable flow and normal flow, and 2+ indicatin g increased flow. Color flow maps were constructed in 47 men with clin ically localized prostate cancer treated by radical prostatectomy (RP) and compared to their whole mount RP specimen step sections. Results, Color flow detected within the index tumor was graded as 2+ in 22 of 47 patients and 0 or 1+ in the remaining 25. Tumors graded 2+ correlat ed with higher Gleason grade, higher incidence of seminal vesicle inva sion, and higher relapse rate, with only 11 of 22 patients disease fre e based on undetectable prostate-specific antigen (PSA) levels. In con trast, 24 of 25 patients with tumors graded 0 or 1+ are free of bioche mical relapse with a median follow-up of 30.9 months. Patients with in creased flow were 10.2 times more likely to relapse even after correct ion for other prognostic variables. In addition, tumors with 2+ capsul ar flow correlated with a higher incidence of non-organ-confined disea se. Conclusions. Color-coded Doppler flow within the tumor and overlyi ng capsule appears to correlate with both tumor grade and stage, respe ctively. Detection and grading of color-coded flow within biopsy-prove n cancers may identify patients with a high likelihood of biochemical relapse. (C) 1997, Elsevier Science Inc. All rights reserved.