Color Doppler imaging and transrectal sonography of the prostatic fossa after radical prostatectomy: early experience.

Abstract

Our objective was to determine if the addition of color Doppler imaging (CDI) during transrectal sonography can improve the detection of residual or recurrent prostatic cancer after radical prostatectomy. Thirty patients who had undergone radical prostatectomy for prostatic cancer were evaluated with transrectal sonography and transrectal sonography with CDI. Twenty-three of these 30 patients were evaluated for suspicion of local tumor recurrence. The remaining seven patients were not suspected of harboring recurrent tumor and served as controls. Transrectal sonography and CDI-directed needle biopsies of the vesicourethral anastomosis (four-quadrant) and perianastomotic soft tissues were obtained in the 23 patients suspected of recurrent tumor. The ability of transrectal sonography to detect local tumor recurrence was compared with transrectal sonography with CDI. Fourteen of 23 patients (61%) had positive transrectal sonography or transrectal sonography and CDI-directed biopsies. Transrectal sonography alone detected grayscale abnormalities in 11 of 23 patients (48%), of whom 10 (43%) had positive transrectal sonography-directed biopsies. CDI during transrectal sonography showed hypervascularity in 12 of 23 patients (52%). Biopsies of these hypervascular regions were positive in all 12 patients (100%). Hypervascularity was detected in 10 of 11 (91%) gray-scale abnormalities initially detected with transrectal sonography alone. CDI during transrectal sonography detected two patients with hypervascular areas without associated gray-scale findings. Both patients had positive biopsies of their hypervascular sites. Transrectal sonography had a sensitivity and specificity of 71% and 89%, respectively, with positive and negative predictive values of 91% and 67%, respectively. CDI during transrectal sonography had a sensitivity and specificity of 86% and 100%, respectively, with positive and negative predictive values of 100% and 82%, respectively. CDI used during transrectal sonography improves the detection of early recurrent or residual prostatic cancer compared with transrectal sonography alone. Although most gray-scale abnormalities that are recurrent tumor show hypervascularity, CDI can detect additional tumor recurrences not identifiable with transrectal sonography alone.