2012 Vardenafil Mediated Image Amplification in Power Doppler Ultrasound Diagnostics of Prostatic Diseases

Abstract

INTRODUCTION AND OBJECTIVES: Although the efficacy of real-time tissue elastography (RTE) for prostate cancer detection has been reported, the procedure is highly operator dependent. We speculated that the use of a pressure device might decrease operator dependency and increase the detection rate of RTE. A pressure device driven water pressure was developed for this study, which we termed real-time balloon inflation elastography (RBIE), and the procedure investigated for its effectiveness in detecting prostate cancer. METHODS: From July, 2008 to February, 2009, 87 patients had abnormal digital rectal examination (DRE), PSA, and/ or TRUS findings, and were enrolled in this study. Their median age was 73 years -old (range 54-89), median PSA was 7.6 ng/mL (range 0.8-2606.0), and the median number of biopsy cores obtained from each was 8 (range 8-10). All patients were examined with MRI prior to prostate needle biopsy and a total of 733 specimens obtained by systemic biopsies were studied. The findings of RTE, RBIE, TRUS, PDUS, and MRI [T2WI, dynamic contrast enhanced images imaging (DCEI)] were compared with histopathological findings of the biopsy specimens.RESULTS: Prostate cancer was detected in 48 of 87 patients (55.2%), and 178 of 733 specimens (24.3%), of which 49, 56, and 73 specimens had Gleason scores of 5-6, 7, and 8-10, respectively. Clinical stage was T1c, T2a-c, T3a-b, and T4 in 6, 26, 10, and 6 cases, respectively. The sensitivity of RBIE, RTE, TRUS, PDUS, T2WI, and DCEI was 72.5%, 71.9%, 75.8%, 75.8%, 72.5%, and 71.3%, respectively, while specificity was 97.7%, 85.8%, 85.4% 86.6%, 89.7%, and 91.5%, respectively. Sensitivity and specificity of RBIE were both superior to those of MRI.CONCLUSIONS: RBIE is known to be a low cost and less invasive procedure, while its prostate cancer detection capability may be superior to that of MRI, which is expensive and time consuming.INTRODUCTION AND OBJECTIVES: Real-time sonoelastography (HI-RTE) has been proven capable to visualize prostate cancer (PCa) areas and therefore can be used for PCa detection. However, application and assessment of this novel technique has several limitations that are important to know for the design of future studies. We evaluated the role of HI-RTE limitations by applying this method to patients before undergoing radical retropubic prostatectomy (RRP) and comparing the results with whole mounted sections.METHODS: In this study 800 prostate sectors with biopsy proven PCa scheduled for RRP were included and underwent HI-RTE by 2 investigators. HI-RTE was done by using a transrectal ultrasound probe (EUB-7500HV Hitachi medical systems with EUP-V53W probe). Local elastography findings were compared with histology. Areas suspicious for PCa were depicted and documented blinded to the pathological reports. RRP specimens were serially step sectioned and whole mounted after a modified Stanford protocol, tumour areas were marked by felt pen and each prostate was divided into 16 sectors. Areas suspicious for PCa were correlated with the correspond...