title: Transperineal prostate biopsy after abdominoperineal resection.
abstract: OBJECTIVE
  Prostate cancer evaluation in men who have undergone abdominoperineal resection poses a challenge for urologists. Diagnosis and staging methods are limited because as access to the prostate via digital rectal examination is not possible. Prostate specific antigen (PSA) has been used to screen for malignancy in this population. However, the conventional diagnostic technique with transrectal ultrasound guided biopsies cannot be used. Transperineal ultrasound and biopsy have been described to evaluate the prostate in this setting. We report our experience with transperineal ultrasound biopsy for evaluating the prostate in patients with elevated PSA who have previously undergone abdominoperineal resection.
  
  
  METHODS
  We reviewed the records of 28 patients treated at 2 institutions. All patients had a history of abdominoperineal resection and subsequent transperineal ultrasound guided prostate biopsy for evaluating elevated PSA. Mean serum PSA in this population was 22 ng./ml. (median 9.5, range 4.1 to 237). Abdominoperineal resection was done in 16 patients (57%) for colorectal cancer, in 11 (39%) for ulcerative colitis and in 1 (4%) for familial polyposis coli. Average time since resection was 14 years (range 1 to 33). Five patients had previously undergone radiation therapy as part of treatment for colorectal cancer before transperineal ultrasound biopsy.
  
  
  RESULTS
  Of the 28 biopsies performed 23 revealed prostate cancer, 2 revealed prostatitis and 3 were benign. Average Gleason grade was 6.6 (range 3 to 9). Of the 23 patients with prostate cancer 22 were treated with androgen deprivation therapy (7), prostatectomy (8), external beam (6) and high dose (1) radiation therapy. Of the 8 patients who underwent prostatectomy pathological stage was T2 in 3 and T3 in 4, while pathological findings were not determined in 1 patient in whom the prostate was removed in pieces.
  
  
  CONCLUSIONS
  In patients with a history of abdominoperineal resection and elevated PSA transperineal ultrasound guided biopsy of the prostate can provide an accurate tissue diagnosis.
authors.affiliation: Department of Urology, University of California-San Francisco and UCSF/Mt. Zion Comprehensive Cancer Center, San Francisco, CA, USA.
authors.forename: Katsuto
authors.initials: K
authors.lastname: Shinohara
authors.forename: Mittul
authors.initials: M
authors.lastname: Gulati
authors.forename: Theresa  M
authors.initials: T
authors.lastname: Koppie
authors.forename: Martha K
authors.initials: MK
authors.lastname: Terris
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods; D003093:Colitis, Ulcerative / Q000601:surgery; D003110:Colonic Neoplasms / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D018084:Ultrasonography, Interventional
chemical_list: D017430:Prostate-Specific Antigen