Vardenafil mediated image amplification in power doppler ultrasound diagnostics of prostatic diseases

Prostate cancer (PCa) and inflammatory changes in the prostate are associated with an elevated microcirculation density within the involved areas.Transrectal ultrasound with Contrast Enhanced Power Doppler (CEPDU) can provide a valuable diagnostic approach in detecting these areas.Phosphodiesterase-5 inhibitors (PDE5-I) induce nitric oxide (NO) mediated vasodilatation of the prostatic circulation (expecialy in the region of periurethral e bladder neck tissue).The aim of this study is to evaluate PDE5-I capacity on increasing the prostatic microcirculation visibility and hence the capacity to detect suspected areas,similarly as the use of CEPDU. METHODS Ninety-five patients with elevated PSA serum levels and both negative DRE and TRUS,have been recruited for the study since May 2008 until now.All patients underwent CEPDU and successive transrectal ultrasound evaluation with Power-Doppler,1 hr after oral somministration of Vardenafil 20 mg (PDE5-IPD. Areas with increased microcirculation,detected with the use of contrast medium,and those,visible after Vardenafil somministration, were recorded.All patients underwent multiple core prostatic biopsy with double sampling from the areas,indicated as suspected by the methods described above. RESULTS In our study 37/75 patients with prostatic pathology were identified by PDE5-IPD,while 28/75 were identified by CEPDU.PDE5-IPD has resulted in higher diagnostic efficacy in comparison to CEPDU exam.The biopsies performed within the areas identified by PDE5-IPD were 91 with 71.43% of these resulting positive for pathologic changes (PCa or inflammatory changes).The CEPDU exam has led to 110 biopsies with only 52.73% of them resulting positives, while with standard TRUS method 750 biopsies were performed with only 15.6% of cores positive for pathologic areas.In our study PDE5-IPD results more efficient than CEPDU (12% against the difference at 10 % LOC equal to 10.35%) and more sensitive than CEPDU (18,7% against the difference at 10 % LOC equal to 8,68%). CONCLUSIONS The association of Vardenafil and conventional transrectal ultrasound technique with Power Doppler,has reported better results to those obtained with the use of ultrasound contrast medium (CEPDU),confirming though it's high sensitivity to individuate either inflammatory changes,or PCa lesions.Introduction of this association could re-evaluate the utility of contrast medium for ultrasound evaluation of the prostate.The advantages of Vardenafil:durable effect,different mechanism of action, lower invasiv