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color doppler again

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Posted 8/1/2011 8:32 PM (GMT 0)
An interesting new study by Taverna et al, the first item in the New Prostate Cancer Infolink (http://prostatecancerinfolink.net/) concludes that color doppler is no more effective than standard ultrasound in detecting pca. I tracked down the original article, and it is well summarized at Prostate Cancer Infolink.

As someone who has been through 4 biopsies, an mri, and more, I found the article persuasive and discouraging. I would love to see somebody poke some holes in it.

It may well be that the it is the operator rather than the machine that makes the difference in pca detection, just as in types of surgery. But I do not see anybody proving that.
Posted 8/1/2011 8:54 PM (GMT 0)
There have been several threads here about  color doppler... Some guys swear by it - others point out that it misses about 4 out of 10 guys with cancer.
Posted 8/1/2011 9:15 PM (GMT 0)
In my opinion, I would rather have color doppler imaging to direct needles then anything else. Dr. Fred Lee, a man that has bad stats for PC for over 20 years, proved to oncologists back in the day that his color doppler imaging was superior. His updated proceedure is even better as it delineates the areas of concer within the prostate as well as showing blood flow to any cancerous tissue. Research Dr. Fred Lee and his protege Dr, Duke Bahn.
Posted 8/1/2011 10:03 PM (GMT 0)
Ditto....to Trepidation post............so true it depends on the doc reading the CDU....you can't go wrong if you go to one of the few masters...most of the other docs see no value in it.....if you have had the experience of seeing one of the  masters you know what I mean.....otherwise you think whats the big deal,not worth the time & trouble....................Cooper wink
Posted 8/1/2011 11:01 PM (GMT 0)
There have been several published studies on CDU; some show a definate benefit and others show no benefit. This is one that shows no benefit so in general the evidence is not sufficient one way or the other.

There is no doubt that some operators such as Fred Lee and Duke Bahn have had very good results with it and the technology may be very skill dependent with a skilled operator able to see things that a standard grey scale cannot see.

My own opinion is that for the normal detection of PC on the 1st biopsy it is probably not worth it. For cases that have a negative biopsy and signs of rising psa it is worth getting the 2nd or third biopsy with a CDU from a specialist. I think the value of CDU is in staging patients more accurrately as to the size, location, and the agressiveness of the tumor.
JohnT
Posted 8/1/2011 11:43 PM (GMT 0)
John, on the entire CDU subject, I have always felt you have made a good case for its use, especially in your own case. Still bothers me, that based on doctors I have spoken to on the subject, not a one puts any value on its use for PC in particular. They have all pointed out the false readings from it, and inconclusive findings.

If it were that good, I would think (just my personal opinion), then it would be in wide use across the country. The small handful of experts that you mention is good of course, but if something is that valuable, it shouldn't be limited to just 2-3 experts, that many people wouldn't have access to.

The hardware isnt' that expensive, not compared to some state of the art MRI machine like I just used, or the lastest and bestest radiation machine, so not convinced cost is the real issue. There must be a lot of doctors out there that don't see the value in general.

david in sc

ps. i am not personaly against the use of CDU at all, just repeating what i have been told
Posted 8/1/2011 11:53 PM (GMT 0)
Here are the articles from the InfoLink on CDU:

prostatecancerinfolink.net/?s=color+doppler

The German study with 1,700 patients shows a 15% failure to detect rate where TRUS biopsy found the cancer. The Italian study shows no significant improvement in it's use whether contrast aided or not.

I have yet to see a controlled study here in the US.

Tony
Posted 8/2/2011 1:17 AM (GMT 0)
David,
To answer your question I have to refer to what both Dr Bahn and Lee have to say. Color Doppler is old technology and it is very difficult to get new radiologists trained on it because of all the newer fancier equipment out there. Also there is a huge investment in time that not many are willing to invest.
No matter how much I personnaly believe in CDU the evidence is the evidence. What it shows is that in the hands of researchers that there is no statistical difference in PC detection. There are some specialists in pc like Scholz and Dattoli who use it daily, but Scholz will always send any suspicious patient to Bahn to confirm. He says that Bahn is just so much better at reading the scan than he is (and Scholz uses it daily) that there must be a very large element of skill and training in its use. This is why I always recommend that if one gets a CDU it is from Bahn, Lee or Dattoli.
JT
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