The incidence of hyperechoic prostate cancer in transrectal ultrasound-guided biopsy specimens.

OBJECTIVES To estimate the incidence of transrectal ultrasound (TRUS) hyperechoic lesions and of hyperechoic prostate cancer in TRUS-guided biopsy specimens. METHODS We prospectively studied 200 patients with total prostate-specific antigen values less than 20 ng/mL and/or positive results on digital rectal examination who had undergone TRUS-guided prostate biopsy. Each patient underwent laterally directed systemic six-core biopsy plus cores from abnormal TRUS lesions and rectally palpable lesions. Six to 10 biopsy cores were obtained from each patient. RESULTS Hyperechoic lesions were found in 19 patients (9.5%), hypoechoic in 83 (41.5%), and isoechoic in 98 (49.0%). Prostate cancer was diagnosed in 33.0% of study patients. Isoechoic findings on TRUS were recorded in 31.8% of patients diagnosed with prostate cancer, whereas 60.6% of cancers had hypoechoic and 7.6% hyperechoic lesions. There was no significant difference in the mean Gleason score between isoechoic cancers (mean 5.4) and hypoechoic cancers (mean 5.6). However, hyperechoic cancers had a mean Gleason score of 7.0, which was higher when compared with isoechoic and hypoechoic cancers. CONCLUSIONS Biopsy of hyperechoic lesions was positive for prostate cancer in a higher percentage of patients than previously reported in the literature, and Gleason score of these cancers was higher when compared with isoechoic and hypoechoic cancers.

[1]  T. Stamey,et al.  Zonal Distribution of Prostatic Adenocarcinoma: Correlation with Histologic Pattern and Direction of Spread , 1988, The American journal of surgical pathology.

[2]  P. Scardino,et al.  Unusual hyperechoic appearance of prostate cancer on transrectal ultrasonography. , 1992, British journal of urology.

[3]  T. Tammela,et al.  Estimation of prostate cancer risk on the basis of total and free prostate-specific antigen, prostate volume and digital rectal examination. , 2002, European urology.

[4]  J. A. Breslin,et al.  Antibiotic prophylaxis in ultrasound guided transrectal prostate biopsy. , 1997, The Journal of urology.

[5]  L. Egevad,et al.  Prediction of the volume of large prostate cancers by multiple core biopsies , 2005, Scandinavian journal of urology and nephrology.

[6]  Georg Bartsch,et al.  Complication rate of transrectal ultrasound guided prostate biopsy: a comparison among 3 protocols with 6, 10 and 15 cores. , 2004, The Journal of urology.

[7]  P. Littrup,et al.  Prostate cancer: the role of transrectal ultrasound and its impact on cancer detection and management. , 2000, Radiologic clinics of North America.

[8]  W. Fair,et al.  Incidence and clinical significance of false-negative sextant prostate biopsies. , 1998, The Journal of urology.

[9]  W. Fair,et al.  Prevalence and predictors of a positive repeat transrectal ultrasound guided needle biopsy of the prostate. , 1997, The Journal of urology.

[10]  J. Ferlay,et al.  Global Cancer Statistics, 2002 , 2005, CA: a cancer journal for clinicians.

[11]  Motonao Tanaka,et al.  [Diagnostic application of ultrasonotomography to the prostate]. , 1968, Nihon Hinyokika Gakkai zasshi. The japanese journal of urology.

[12]  H. Holm,et al.  Ultrasonically guided precise needle placement in the prostate and the seminal vesicles. , 1981, The Journal of urology.

[13]  M. Terris,et al.  Extended field prostate biopsies: too much of a good thing? , 2000, Urology.

[14]  Jan Lehmann,et al.  Transrectal ultrasound guided biopsy of the prostate: random sextant versus biopsies of sono-morphologically suspicious lesions , 2004, World Journal of Urology.

[15]  P. Scardino,et al.  The appearance of prostate cancer on transrectal ultrasonography: correlation of imaging and pathological examinations. , 1989, The Journal of urology.

[16]  T. Stamey,et al.  Making the most out of six systematic sextant biopsies. , 1995, Urology.

[17]  M. Rifkin,et al.  Should Ultrasound Criteria of the Prostate Be Redefined to Better Evaluate When and Where to Biopsy , 2001, Ultrasound quarterly.

[18]  W. Ellis,et al.  The significance of isoechoic prostatic carcinoma. , 1994, The Journal of urology.

[19]  L. Kiemeney,et al.  A comparison of the diagnostic performance of systematic versus ultrasound-guided biopsies of prostate cancer , 2006, European Radiology.

[20]  E. Caturelli,et al.  Transrectal ultrasonography for the early diagnosis of adenocarcinoma of the prostate: a new maneuver designed to improve the differentiation of malignant and benign lesions. , 2003, The Journal of urology.

[21]  F. Khan,et al.  TRANSRECTAL ULTRASOUND GUIDED BIOPSY OF THE PROSTATE , 1998 .

[22]  N. Webb,et al.  Antibiotic prophylaxis for prostate biopsy , 2002, BJU international.

[23]  R. Malik,et al.  Transrectal ultrasonography for evaluation of various benign and malignant prostatic lesions and their histopathological correlation , 2004 .

[24]  M. Stilmant,et al.  Transrectal ultrasound screening for prostatic adenocarcinoma with histopathologic correlation. Factors affecting specificity , 1993, Cancer.

[25]  V. Reuter,et al.  Clinical significance of repeat sextant biopsies in prostate cancer patients. , 1997, Urology.

[26]  B. Krušlin,et al.  Complications of Transrectal Ultrasound Guided Prostate Needle Biopsy: Our Experience and Review of the Literature , 2006 .