Centre d'Imagerie Médicale, 6, passage Jules-Didier, 70000 Vesoul, France.
Diagn Interv Imaging. 2013 Jan;94(1):60-7. doi: 10.1016/j.diii.2012.09.003. Epub 2012 Dec 2.
To evaluate the risk of low-risk prostate cancer or prostate cancer that may benefit from surveillance in patients with a PSA level less than 10 ng/ml, a normal digital rectal examination (DRE) and a transrectal power Doppler sonography (PDS) without anomaly.
Two hundred and forty-three consecutive patients with a PSA level less than 10 ng/ml and a DRE without anomaly had PDS-guided biopsies: 12 to 15 samples were systematically taken and echo-guided in the suspect areas. The PDS results were rated from 1 to 4: 1: normal, 2: slightly hypoechogenic avascular area in which the hypo-echogenicity disappears after compression by probe, 3: hypoechogenic avascular area, 4: hypoechogenic vascularised area with power Doppler sonography. Patients rated 3 or 4 were considered to be pathological. D'Amico's criteria were used to assess the risk of a biological recurrence after treatment and those of Dall'Era were used to select the patients that could benefit from active surveillance (AS). The PDS was considered to be a true positive if at least one biopsy was positive in the same sextant as the suspect image.
In a prospective manner, 106 cancers were diagnosed that could be qualified as low-risk in 84% of the cases (89% with a normal PDS and 79% with an abnormal PDS). Sixty-nine percent of the cases could be subject to AS (86% of the normal PDS cases and 47% of the abnormal PDS cases; P<0.001). The PDS was normal in 159 of the 243 patients (65%). With a normal PDS, there was a 96% probability of not having a high-risk cancer. With an abnormal PDS, at least one biopsy was positive in 57% of the cases and the probability of having a significant cancer was 30% according to the Dall'Era criteria. A significant reduction was noted with a normal PDS, to 36% and 5%, respectively (VPN=95%) (P=0.015).
A normal PDS in patients presenting a PSA level less than 10 ng/ml and a DRE without anomaly may be used to put off the indication for a biopsy in order to reduce their number as well as the risks of overtreatment for a latent cancer.
评估 PSA 水平<10ng/ml、直肠指诊（DRE）正常且经直肠彩色多普勒超声（PDS）无异常的患者中低危前列腺癌或可能受益于监测的前列腺癌的风险。
243 例 PSA 水平<10ng/ml 且 DRE 无异常的连续患者接受了 PDS 引导下的活检：系统地采集 12-15 个样本，并在可疑区域进行回声引导。根据 1-4 分对 PDS 结果进行评分：1：正常，2：轻度低回声乏血管区，探头压迫后低回声消失，3：低回声乏血管区，4：低回声血管化区，彩色多普勒超声。评分 3 或 4 的患者被认为是病理性的。采用 D'Amico 标准评估治疗后发生生物学复发的风险，采用 Dall'Era 标准选择可能受益于主动监测（AS）的患者。如果同一 sextant 中有至少一个活检呈阳性，则认为 PDS 为真阳性。
前瞻性地诊断出 106 例癌症，其中 84%（正常 PDS 为 89%，异常 PDS 为 79%）可归类为低危。69%的患者可以进行 AS（正常 PDS 病例为 86%，异常 PDS 病例为 47%；P<0.001）。243 例患者中有 159 例（65%）PDS 正常。PDS 正常时，患高危癌症的概率为 96%。PDS 异常时，57%的病例至少有一个活检呈阳性，根据 Dall'Era 标准，患显著癌症的概率为 30%。PDS 正常时，显著癌症的概率分别降至 36%和 5%（VPN=95%）（P=0.015）。
对于 PSA 水平<10ng/ml 且 DRE 无异常的患者，若 PDS 正常，可推迟活检的适应证，以减少活检数量和过度治疗潜伏性癌症的风险。
