COLOR DOPPLER-GUIDED PROSTATE BIOPSIES IN 591 PATIENTS WITH AN ELEVATED SERUM PSA LEVEL - IMPACT ON GLEASON SCORE FOR NONPALPABLE LESIONS

Objectives. To compare results of color Doppler-guided ultrasonography (CDUS) versus those of systematic biopsies in 591 patients with an el evated serum PSA level and to correlate them with digital rectal exami nation (DRE) findings. Methods. Biopsies were directed into hypervascu larized (CDUS+) or hypovascularized (CDUS-) hypoechoic peripheral zone nodules (443 cases). When transrectal ultrasound (TRUS) was normal (1 48 cases), biopsies were directed into hypervascular areas. Six additi onal posterior biopsies were also performed in every patient, together with four anterior biopsies in 117 patients with normal DRE and prost ate weight above 40g. Results. Biopsies were positive in 339 patients (57%). Positive biopsy rate (PER) of directed biopsies was 84% in hype rvascular abnormalities (264 of 316) and 17% in hypovascular nodules ( 23 of 134) (P < 0.001). PER of combined biopsies was 84% in CDUS+ pati ents (266 of 316) and 26% in CDUS- patients (73 of 275) (P < 0.001). C omparison of TRUS and CDUS showed a sensitivity of 0.9 and 0.78, respe ctively, and a specificity of 0.46 and 0.8, respectively. Of the 131 p atients with a PSA level between 4 and 10 ng/mL and a normal DRE, PER was 59% (22 of 37) when CDUS was positive and 11% (10 of 94) when it w as negative, regardless of TRUS abnormalities (P < 0.001). Nonpalpable cancers with a negative CDUS showed a significantly (P < 0.001) lower Gleason score (5.5 +/- 0.9) than that of CDUS+ cancers (6.5 +/- 1.1). Eleven cancers were diagnosed by only anterior positive biopsies. All of them had a negative CDUS and a PSA level above 10 ng/mL. Conclusio ns. CDUS does not modify prostate biopsy policy except in patients wit h negative CDUS, normal DRE, and PSA level between 4 and 10 ng/mL, whe re deferment of biopsy can be advocated. Anterior biopsies are only us eful in patients with a PSA level above 10 ng/mL and a negative CDUS. (C) 1997, Elsevier Science Inc.