The objective of the study was to determine the role of Power Doppler for initial diagnosis of prostate cancer, for extraprostatic invasion assessment, for tumour size determination and for evaluation of the cellular differentiation using the tumour vascularization index. A total of 87 patients with a hypoechogenous structure in the area of the posterior prostate periphery were examined. In the case of localized cancers, Power Doppler results were compared with the histological findings of sextant biopsy and radical prostatectomy. The vascularization rate was quantified using a vascularization index of 1 to 3. The prospective evaluation of extraprostatic invasion of the tumour was stated for 21 patients who underwent radical prostatectomy. Power Doppler has a 98.1% sensitivity and a 77.1% specificity in respect of the diagnosis of a prostate cancer. For disease prevalence of 0.4 to 0.9, the examination’s positive predictive value is 86.4 to 74% and the negative predictive value is 96.4 to 98.4% (p = 0.02). It was ascertained that in locally advanced tumours, tumour vascularization exceeded the borders of the hypoechogenous structure and biopsy using Power Doppler facilitated a more precise determination of the tumours size. In respect of localized tumours, the presence of central abnormal vascularization was often associatedwith the mass effect. Three qualitative types of vascularization were differentiated: A, B, and C, where probability of extraprostatic invasion was prospectively determined. In 8 type A cases (central vascularization of the tumour and a regular avascular prostatic capsule) no extraprostatic invasion was ascertained in 7 patients (a 12.5% invasion risk). In 8 type C cases (ample tumour vascularization affecting the periphery and attenuating or penetrating the prostatic capsule), invasion was ascertained in 6 patients (a 75% invasion risk). A vascularization index equal to or higher than 3 was found in 20 patients out of 40 with Gleason’s score equal to or higher than 7, and in 6 patients out of 17 with Gleason’s score below 7 (R = 0.283, p = 0.033).

        Key words: power Doppler - 3D reconstruction - vascularization - prostate cancer - extraprostatic