Gray scale and color Doppler ultrasonography findings in the diagnosis of prostate cancer

Abstract

Purpose: The aim of this study is to investigate the relationship between tumoral malignancy potentials and transrectal gray scale ultrasonographic findings in prostate cancer and to investigate the contribution of transrectal color Doppler ultrasonography to the diagnosis.

Material and Methods: We retrospectively evaluated 63 patients with prostate cancer who underwent transrectal associated biopsy in our study. In all patients, gray scale ultrasonography, color Doppler ultrasonography findings, serum PSA levels, pathology results were compared and the relationship between them was investigated.

Results: While moderately differentiated tumors were more hypoecogenic (69%), poorly differentiated tumors were observed to be mixed echogenicity (58%). All of the isoecogenic tumors were in the good or moderate differentiation group. In 11 (17%) of 65 cancer centers, no blood flow was detected in Doppler US (grade 0). Eight (12%) of 65 patients had first degree blood flow, while 46 (71%) had second degree blood flow.  It was determined that the PSA values significantly increased as the degree of vascularization of the lesions increased. Significant correlations were also found between the Gleason scores of the tumors and the blood flow grade. All lesions with no evidence of color Doppler ultrasonography are found in the good or moderately differentiated cancer group. On the other hand, the majority (98%) of the cancers in which significant blood flow is detected are found in the moderate or poorly differentiated group.

Conclusion: There was no additional contribution of color Doppler ultrasonography to gray scale ultrasonography in detecting prostate cancer. However, it has been observed that the gray scale ultrasonography contributes to the manifestation of suspicious lesions. Significant links between cancer blood levels and Gleason scores were noted. Accordingly, it has been observed that cancers that show significant blood flow with color Doppler ultrasonography have higher malignancy than cancers that do not have blood or minimal blood supply.

Keywords

• Prostate cancer,transrectal ultrasonography,color Doppler ultrasonography,Gleason score

Prostat kanserinin tanısında gri skala ve renkli Doppler ultrasonografinin yeri

Öz

Özet

Amaç: Bu çalışmanın amacı prostat kanserinde transrektal gri skala ultrasonografi (US) bulguları ile tümörlerin malignite potansiyelleri arasındaki ilişkiyi incelemek ve transrektal renkli Doppler ultrasonografinin (RDUS) tanıya olan katkısını araştırmaktır.

Gereç ve Yöntem: Çalışmamızda TRUS eşliğinde yapılan biyopsi sonrası prostat kanseri saptanan 63 olgu retrospektif olarak değerlendirilmiştir. Hastaların tümünde gri skala US, RDUS bulguları, serum PSA düzeyleri, patoloji sonuçları karşılaştırılmış ve aralarındaki ilişki araştırılmıştır.

Bulgular: Orta diferansiye tümörler daha çok hipoekojenik iken (%69), kötü diferansiye tümörlerin mikst ekojenitede oldukları gözlenmiştir (%58). İzoekojenik tümörlerin tümü iyi ya da orta derece diferansiye grupta yer almışlardır. Toplam 65 kanser odağının 11’inde (%17) Doppler bakıda kanlanma saptanmazken (derece 0), 8’inde (%12) 1. derece ve 46’sında (%71) 2. derece kanlanma izlenmiştir. Lezyonların kanlanma derecesi arttıkça PSA değerlerinin belirgin olarak arttığı belirlenmiştir. Tümörlerin Gleason skorları ile kanlanma dereceleri arasında da önemli bağlantılar tespit edilmiştir. RDUS ile kanlanma saptanmayan lezyonların tamamı iyi ya da orta derece diferansiye kanser grubundadır. Buna karşın belirgin kanlanma saptanan kanserlerin büyük çoğunluğu (%98) orta ya da kötü diferansiye grupta yer almaktadır.

Sonuç: Prostat kanseri saptanmasında RDUS’nin gri skala US’ye ilave katkısı bulunmamıştır. Ancak gri skala US ile kuşkulu lezyonların manifest hale gelmesine katkıda bulunduğu gözlenmiştir. Kanserlerin kanlanma dereceleri ile Gleason skorları arasında önemli bağlantılar dikkati çekmiştir. Buna göre RDUS ile belirgin kanlanma gösteren kanserlerin, kanlanmayan ya da minimal kanlanma izlenen kanserlere göre daha yüksek maligniteye sahip oldukları gözlenmiştir.

Anahtar Kelimeler

• Prostat kanseri,transrektal ultrasonografi,renkli Doppler ultrasonografi

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