title: [Role of prostate fossa ultrasonography in the diagnosis of local recurrence after radical prostatectomy in case of PSA failure].
abstract: OBJECTIVE
  The aim of this study is to verify the diagnostic accuracy of transrectal ultrasound (TRUS) of vesico-urethral anastomosis in patients with PSA elevation (> or = 0.2 ng/mL) after radical prostatectomy, who received 4-6 random anastomotic biopsies of the prostatic fossa plus additional biopsies directed to TRUS detectable lesions.
  
  
  METHODS
  Since 1992 up to now, 102 patients (mean age: 68.3 +/- 5.4 years) with PSA elevation after radical prostatectomy underwent TRUS of the vesico-urethral anastomosis and 4-6 TRUS-guided random biopsies plus 1-2 additional biopsies directed to TRUS detectable lesions. Pathologic stage was B (ASS classification) in 60% of cases, C in 36% and D in 4% (patients without hormonal treatment who underwent TRUS-guided biopsy because of TRUS detectable or palpable lesion).
  
  
  RESULTS
  The mean PSA at biopsy time was 2.1 +/- 4.6 (SD) ng/mL (range: 0.2-31.6 ng/mL) with median PSA of 0.9 ng/mL. DRE was positive in 37% of cases, while TRUS was positive in 73%. Recurrent adenocarcinoma was detected in 51% of all patients and in 45% (26/57) of patients with PSA < 1.0 ng/mL. TRUS sensitivity was higher (80%) than DRE (50%), but specificity was lower (37% vs 81%). The positive predictive value of TRUS detectable lesion was 60%. TRUS sensitivity and specificity increase with PSA elevation and sonographic aspects of prostatic fossa are statistically correlated with histology when PSA > 1.2 ng/mL.
  
  
  CONCLUSIONS
  TRUS of the vesico-urethral anastomosis seems to be more sensitive but less specific than DRE for prostatic cancer local recurrence. More than half of TRUS detectable lesions is positive at biopsy. TRUS and TRUS-guided biopsy accuracy are directly correlated with PSA elevation.
authors.affiliation: Clinica Urologica, Università Vita e Salute, Istituto Scientifico Ospedale San Raffaele, Milano. marcoroscigno@tiscalinet.it
authors.forename: Marco
authors.initials: M
authors.lastname: Roscigno
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Scattoni
authors.forename: Marco
authors.initials: M
authors.lastname: Raber
authors.forename: Paolo
authors.initials: P
authors.lastname: Consonni
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Pasta
authors.forename: Roberto
authors.initials: R
authors.lastname: Bertini
authors.forename: Renzo
authors.initials: R
authors.lastname: Colombo
authors.forename: Luigi
authors.initials: L
authors.lastname: Da Pozzo
authors.forename: Massimo
authors.initials: M
authors.lastname: Freschi
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000000981:diagnostic imaging*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000601:surgery*; D012007:Rectum; D015203:Reproducibility of Results; D014463:Ultrasonography; D014521:Urethra / Q000000981:diagnostic imaging* / Q000601:surgery; D001743:Urinary Bladder / Q000000981:diagnostic imaging* / Q000601:surgery
chemical_list: D017430:Prostate-Specific Antigen