OBJECTIVE: To assess whether organ-confined prostate cancer not detected on routine transrectal ultrasonography (TRUS) can be detected using three-dimensional (3-D) power Doppler methods. PATIENTS AND METHODS: A preliminary trial of the use of TRUS with 3-D power Doppler image reconstruction was conducted in 116 patients being evaluated for lower urinary tract symptoms. Using a microbubble enhancing agent, an adequate horizontal plane allowed the simultaneous visualization and assessment of the symmetry of echogenicity and vascularization of the peripheral area of both prostate lobes, which is not possible in standard TRUS. The peripheral zone vascular asymmetry in the horizontal plane was also assessed retrospectively in those patients with pT2a,b prostate carcinoma. RESULTS: Stage pT2a,b prostate carcinoma was confirmed in 26 patients; in this group, two independent investigators confirmed the vascular asymmetry between the left and right peripheral zone, in the horizontal plane, in 22 patients, giving a sensitivity of 85%. CONCLUSIONS: Vascular asymmetry allows guided biopsy in lesions that are invisible using standard TRUS. Microbubble agents are an effective method of increasing the acoustic signals from small vessels of the prostate.
OBJECTIVE: To assess whether organ-confined prostate cancer not detected on routine transrectal ultrasonography (TRUS) can be detected using three-dimensional (3-D) power Doppler methods. PATIENTS AND METHODS: A preliminary trial of the use of TRUS with 3-D power Doppler image reconstruction was conducted in 116 patients being evaluated for lower urinary tract symptoms. Using a microbubble enhancing agent, an adequate horizontal plane allowed the simultaneous visualization and assessment of the symmetry of echogenicity and vascularization of the peripheral area of both prostate lobes, which is not possible in standard TRUS. The peripheral zone vascular asymmetry in the horizontal plane was also assessed retrospectively in those patients with pT2a,b prostate carcinoma. RESULTS: Stage pT2a,b prostate carcinoma was confirmed in 26 patients; in this group, two independent investigators confirmed the vascular asymmetry between the left and right peripheral zone, in the horizontal plane, in 22 patients, giving a sensitivity of 85%. CONCLUSIONS: Vascular asymmetry allows guided biopsy in lesions that are invisible using standard TRUS. Microbubble agents are an effective method of increasing the acoustic signals from small vessels of the prostate.