Urology Unit, Department of Surgery, University of Pisa, New Santa Chiara Hospital-Cisanello, Pisa, Italy.
J Urol. 2011 Jun;185(6):2126-31. doi: 10.1016/j.juro.2011.02.014. Epub 2011 Apr 15.
We evaluated the ability of the phosphodiesterase-5 inhibitor vardenafil to increase prostate microcirculation during power Doppler ultrasound. We also evaluated the results of contrast and vardenafil enhanced targeted biopsies compared to those of standard 12-core random biopsies to detect cancer.
Between May 2008 and January 2010, 150 consecutive patients with prostate specific antigen more than 4 ng/ml at first diagnosis with negative digital rectal examination and transrectal ultrasound, and no clinical history of prostatitis underwent contrast enhanced power Doppler ultrasound (bolus injection of 2.4 ml SonoVue® contrast agent), followed by vardenafil enhanced power Doppler ultrasound (1 hour after oral administration of vardenafil 20 mg). All patients underwent standard 12-core transrectal ultrasound guided random prostate biopsy plus 1 further sampling from each suspected hypervascular lesion detected by contrast and vardenafil enhanced power Doppler ultrasound.
Prostate cancer was detected in 44 patients (29.3%). Contrast and vardenafil enhanced power Doppler ultrasound detected suspicious, contrast enhanced and vardenafil enhanced areas in 112 (74.6%) and 110 patients (73.3%), and was diagnostic for cancer in 32 (28.5%) and 42 (38%), respectively. Analysis of standard technique, and contrast and vardenafil enhanced power Doppler ultrasound findings by biopsy core showed significantly higher detection using vardenafil vs contrast enhanced power Doppler ultrasound and standard technique (41.2% vs 22.7% and 8.1%, p <0.005 and <0.001, respectively). The detection rate of standard plus contrast or vardenafil enhanced power Doppler ultrasound was 10% and 11.7% (p not significant).
Vardenafil enhanced power Doppler ultrasound enables excellent visualization of the microvasculature associated with cancer and can improve the detection rate compared to contrast enhanced power Doppler ultrasound and the random technique.
我们评估了磷酸二酯酶-5 抑制剂伐地那非在超声能量多普勒中的作用，以增加前列腺微循环。我们还评估了与标准的 12 针随机活检相比，造影剂和伐地那非增强靶向活检在检测癌症方面的结果。
2008 年 5 月至 2010 年 1 月，连续 150 例前列腺特异性抗原首次诊断值超过 4ng/ml，直肠指检和经直肠超声均为阴性，且无前列腺炎病史的患者接受造影剂增强超声能量多普勒检查（团注 2.4ml SonoVue®造影剂），随后给予伐地那非增强超声能量多普勒检查（口服伐地那非 20mg1 小时后）。所有患者均接受标准的 12 针经直肠超声引导下随机前列腺活检，外加从造影剂和伐地那非增强超声能量多普勒检查中检测到的每个可疑高血管病变中各取 1 针。
44 例患者（29.3%）检出前列腺癌。造影剂和伐地那非增强超声能量多普勒检测出可疑、增强和增强的区域分别为 112 例（74.6%）和 110 例（73.3%），诊断出癌症分别为 32 例（28.5%）和 42 例（38%）。对标准技术、活检核心的造影剂和伐地那非增强超声能量多普勒检查结果进行分析，发现伐地那非的检测率明显高于增强超声能量多普勒和标准技术（41.2%vs22.7%和 8.1%，p<0.005 和<0.001）。标准加造影剂或伐地那非增强超声能量多普勒的检测率为 10%和 11.7%（p 无显著性差异）。
伐地那非增强超声能量多普勒可极好地显示与癌症相关的微血管，并能提高与造影剂增强超声能量多普勒和随机技术相比的检测率。
