Utility of Trans Rectal Ultrasound with Power Doppler Imaging Guided Biopsy in the detection of Prostate Cancer.

INTRODUCTION : 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 cancer1. 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. AIM : To evaluate the utility of trans rectal ultrasound with power Doppler imaging guided biopsy in comparison with grey scale imaging in the detection of prostate cancer, 10 core biopsy being the reference standard. MATERIALS AND METHODS : A prospective study was conducted in the time period between July 2006 and May 2009. All the patients more than 50 years who presented to the Urology OPD with LUTS with abnormal digital rectal examination and/or PSA>=4 ng/ml were evaluated for inclusion in the study. Exclusion criteria: 1. No consent for study, 2. Persistent urinary tract infection, 3. Untreated coagulopathy. After obtaining informed consent all the patients were enrolled into the study. Routine clinical evaluation was done as per the proforma and the findings were recorded. All the patients were evaluated by TRUS. On the day prior to the procedure, ciprofloxacin 500mg bd and metronidazole 400 mg tds was prescribed, which was continued for 2 days post procedure. PC enema was given on the day of the procedure. Intravenous pethidine was given as analgesic if the patient did not tolerate pain. CONCLUSION : Power Doppler imaging guided hypervascular area directed biopsy is efficient in the detection of prostate cancer in comparison with hypoechoic nodule directed biopsy