The U.S.A. experience: diagnosis and follow-up of prostate malignancy by transrectal ultrasound.
Our own experience, and a review of the American literature, suggests a number of areas in the diagnosis and follow-up of prostate cancer in which transrectal ultrasonography is a useful adjunct. Accurate clinical staging in patients with known prostate cancer is an obvious area in which this technique had ready and practical impact. Its performance prior to radical prostatectomy should facilitate further ultrasonographic and histopathologic correlation. This imaging modality may be coupled with other devices to guide in a precise manner subsequent biopsy or implantation. Further collaborative efforts in this area are likely to result in a number of new and ingenious methods of mapping the prostate gland for further diagnostic or therapeutic intervention with pinpoint accuracy. At present, one of the most useful applications of transrectal ultrasound is in determining local response to therapy, whether hormonal, radiotherapeutic, or chemotherapeutic. Normalization of the prostatic image is seen in patients sustaining a favorable response to therapy. It is most likely that changes in the prostate following hormonal therapy or chemotherapy for metastatic prostate cancer would mirror the systemic response to therapy, but the correlation of local and systemic response to treatment requires further study and analysis. Finally, there are unresolved problems in the use and interpretation of transrectal ultrasonography as currently employed. Most significantly, ultrasonographic criteria for the diagnosis of prostate cancer are lacking. The internal echo patterns in particular which characterizes prostate cancer defy precise definition, and prostate disorders may be identified with high sensitivity but low specificity. More recent and convincing reports indicate that most prostate cancers are hypoechoic.(ABSTRACT TRUNCATED AT 250 WORDS)
Huben
R P
RP
Department of Urologic Oncology, Roswell Park, Memorial Institute, Buffalo, New York 14263.
D001707:Biopsy, Needle / Q000379:methods; D002277:Carcinoma / Q000175:diagnosis*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000628:therapy; D014463:Ultrasonography / Q000379:methods*