Is power Doppler US a good predictor of prostate cancer aggressiveness

To determine the value of Power Doppler US for the diagnosis of prostate cancer and in the prediction of cancer aggressiveness. One hundred and five consecutive patients with PSA>4 ng/ml and/or abnormal digital rectal exam underwent power Doppler US prior to biopsy. In addition to biopsies directed to suspiscious lesion on US, 10 to 12 standard sextant biopsies were obtained. Histologic results were correlated to imaging findings. A hypervascular lesion (enlarged, irregular, serpentine or disorganized vessels) was present at power Doppler US in 34 patients and corresponded to cancer in 28 cases. Nineteen cancers showed no detectable abnormality on power Doppler US. Cancer was present in 271 of 1093 cores. After correlation with results from sextant prostate biopsy, power Doppler showed a sensitivity of 44%, specificity of 96%, positive predictive value of 84% and negative predictive value of 80%. Positive results on power Doppler US were strongly cotrrelated with higher Gleason scores. Power Doppler US may contribute to the evaluation of prostate cancer aggressiveness and direct biopsies to more aggressive foci.