Role of Power Doppler Imaging with Trans Rectal Ultrasonogram Guided Prostate Biopsy in the Detection of Prostate Cancer.

Prostate cancer is the most common noncutaneous cancer Among males. it accounts for 10% of cancer related deaths in males. According to the american cancer society, 186330 new cases will Be diagnosed in 2008 and 26000 men will die from prostate cancer. Prostate cancer is rarely diagnosed in men younger than 40 years, And it is uncommon in men younger than 50 years. Prostate cancer is Also found during autopsies performed following other causes of Death. The rate of this latent or autopsy cancer is much greater than That of clinical cancer. In fact, it may be as high as 80% by age 80 Years. The diagnosis and treatment of prostate cancer continues to Evolve. With the development of prostate-specific antigen (PSA) Screening and TRUS, prostate cancer is being diagnosed earlier in The disease course. In the present era, most patients present because of Abnormalities in prostate specific antigen (PSA) level or positive Digital rectal examination (DRE) findings while evaluating for BPH, Rather than metastatic symptoms. The combination of DRE and Serum PSA is the most useful first-line test for assessing the Presence of prostate cancer in an individual. however, prostate Cancer can be an incidental pathologic finding when tissue is Removed during transurethral resection to manage obstructive Prostatic symptoms. The presence of prostate disease (prostate cancer, BPH, and Prostatitis) is the most important factor affecting serum levels of PSA. PSA elevations may indicate the presence of prostate disease, but not all Men with prostate disease have elevated PSA levels. Furthermore, PSA Elevations are not specific for cancer. Findings from the DRE are crucial. An irregular firm prostate or Nodule is typical, but many cancers are found in prostates that feel Normal. Dre is a test with only fair reproducibility even in the hands Of experienced examiners that misses a substantial proportion of Cancers. DRE detects most cancers at an advanced pathologic Stage, when treatment is less likely to be effective. Dre misses 23% To 45% of the cancers that are subsequently found with prostatic Biopsies done for serum PSA elevations. A number of studies have confirmed the inability of trus to Localise early prostate cancer. rifkin and colleagues10 found That only 60% of prostate cancers measuring more than 5 mm on Pathologic examination were identified by MRI and that Ultrasonography identified only 59% of these cancers. Flanigan and Associates12 found that only 18% of 855 sonographically suspicious Quadrants actually contained cancer on biopsy, whereas 65% of Quadrants containing cancer were not sonographically suspicious. Any patient with a DRE suspicious for cancer or a PSA elevation Should undergo prostate biopsy regardless of trus findings if an Early diagnosis of cancer would result in a recommendation for Treatment. The original sextant biopsy scheme (one core from the base, Mid, and apex bilaterally) significantly improved cancer detection, Over digitally directed biopsy of palpable nodules and TRUS guided Biopsy of specific hypoechoic lesions. Presti and co-workers found That adding laterally directed cores from the base and midgland Bilaterally improved cancer detection from 80% with standard sextant To 96%. To improve the detection rate with TRUS biopsy various Additional modalities have been tried. This includes power doppler Ultrasonography to evaluate the neovascularity in patients with Prostate cancer. Various studies have shown increased cancer detection rates using doppler-targeted biopsy strategies. To evaluate the Indian perspective regarding the doppler directed targeted biopsy strategies, we decided to conduct a study to evaluate the utility of power doppler ultrasonography in the detection of Prostate cancer