title: [Role of ultrasonography-guided prostatic biopsy of hypoechoic areas associated with systematic biopsies in patients with normal and high PSA levels].
abstract: OBJECTIVE
  The aim of the study is to evaluate the need to perform directed biopsies to hypoechoic areas at transrectal ultrasound associated with a prostatic mapping in patients with normal and elevated levels of PSA.
  
  
  METHODS
  Since January 1987, 517 consecutive patients (mean age: 65.5 +/- 5.2 yrs) underwent selective prostatic biopsies of hypoechoic areas and systematic sextant biopsies with 10 samples in patients with a prostatic volume < 60 g and 12 samples in prostatic volume > 60 g.
  
  
  RESULTS
  The median PSA value was 7.2 +/- 4.6 ng/ml (SD). 52% of the patients had a positive digital rectal examination. Cancer was detected in 47% of the patients (245/517), in 18% (14/78) of patients with PSA level < 4.0 ng/ml, in 42% (109/256) with PSA level from 4 to 10 ng/ml, in 66% (122/183) with PSA > 10 ng/ml. The PSA value was statistically higher (PSA = 14.9 +/- 17) in patients with positive prostatic biopsies compared to patients with negative biopsies (PSA = 8.5 +/- 8.3 ng/ml) (p > 0.0001). The PPV (positive predictive value) of the hypoechoic lesions was 36% (187/517). Cancer was detected only in directed biopsies of the hypoechoic areas regardless of PSA value in the 20% of patients (49/245). Sextant biopsies were positive with negative directed biopsies in 24% (58/245) of the patients, while both directed and sextant biopsies were positive in 56% (138/245) of the patients.
  
  
  CONCLUSIONS
  The hypoechoic lesion is the prostatic area in which prostatic cancer is most likely to be located in spite of the fact that the PPV of a hypoechoic area is less than 40%. The combination of sextant and lesion-directed biopsies maximizes the detection rate using the lowest possible number of biopsy cores. In the case of a TRUS visible lesion, the optimal number and placement of added systematic biopsies is yet to be defined. Due to the multifocality of prostate cancer, in the future, it is probable that, by adding more biopsies to the sextant standard scheme, the necessity of biopsying single small hypoechoic lesions will no longer be necessary.
authors.affiliation: Dpt of Urology, Scientific Institute H San Raffaele, 20145 Milan, Italy. scattoni.vincenzo@hsr.it
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Scattoni
authors.forename: Marco
authors.initials: M
authors.lastname: Roscigno
authors.forename: Marco
authors.initials: M
authors.lastname: Raber
authors.forename: Paolo
authors.initials: P
authors.lastname: Consonni
authors.forename: Massimo
authors.initials: M
authors.lastname: Freschi
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Pasta
authors.forename: Renzo
authors.initials: R
authors.lastname: Colombo
authors.forename: Luciano
authors.initials: L
authors.lastname: Nava
authors.forename: Lina
authors.initials: L
authors.lastname: Bua
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods; D006801:Humans; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000473:pathology*; D012007:Rectum; D014463:Ultrasonography
chemical_list: D017430:Prostate-Specific Antigen