Computerized transrectal ultrasound (C-TRUS) of the prostate: detection of cancer in patients with multiple negative systematic random biopsies.
This study was designed to compare the diagnostic yield of computerized transrectal ultrasound (C-TRUS) guided biopsies in the detection of prostate cancer in a group of men with a history of multiple systematic random biopsies with no prior evidence of prostate cancer. The question was asked: Can we detect cancer by C-TRUS that has been overlooked by multiple systematic biopsies? The entrance criteria for this study were prior negative systematic random biopsies regardless of number of biopsy sessions or number of individual biopsy cores. Serial static TRUS images were evaluated by C-TRUS, which assessed signal information independent of visual gray scale. Five C-TRUS algorithms were utilized to evaluate the information of the ultrasound signal. Interpretation of the results were documented and the most suspicious regions marked by C-TRUS were biopsied by guiding the needle to the marked location. Five hundred and forty men were biopsied because of an elevated PSA or abnormal digital rectal exam. 132 had a history of prior negative systematic random biopsies (1-7 sessions, median: 2 and between 6 and 72 individual prostate biopsies, median: 12 cores). Additionally, a diagnostic TUR-P of the prostate with benign result was performed in four patients. The PSA ranged from 3.1-36 ng/ml with a median of 9.01 ng/ml. The prostate volume ranged from 6-203 ml with a median of 42 ml. Of the 132 patients with prior negative systematic random biopsies, cancer was found in 66 (50%) by C-TRUS targeted biopsies. In this group the median number of negative biopsy sessions was two and a median of 12 biopsy cores were performed. From literature we would expect a cancer detection rate in this group with systematic biopsies of approximately 7%. We only found five carcinomas with a Gleason Score (GS) of 5, 25 with GS 6, 22 with GS 7, 8 with GS 8 and even 7 with GS 9. The results of this prospective clinical trail indicates that the additional use of the C-TRUS identifies clinical significant cancerous lesions that could not been visualized or detected by systematic random biopsies in a very high percentage. In addition, the results of the study support the efforts to search for strategies that utilize expertise and refinement of imaging modalities rather than elevating the number of random biopsies (f.e. 141 cores in one session) in the detection of prostate cancer.
Loch
Tillmann
T
Klinik für Urologie des Diakonissenkrankenhaus Flensburg, Lehrkrankenhaus der Christian-Albrechts-Universität Kiel des Universitätsklinikums Schleswig-Holstein, Marienhoelzungsweg 2, 24939 Flensburg, Germany. lochti@diako.de
D000368:Aged; D001706:Biopsy / Q000379:methods; D003937:Diagnosis, Differential; D019160:Endosonography / Q000379:methods*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000000981:diagnostic imaging* / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D012007:Rectum; D015203:Reproducibility of Results
Urologe A. 2000 Jul;39(4):341-7
10957776
J Urol. 2004 Mar;171(3):1089-92
14767277
J Urol. 1994 Dec;152(6 Pt 2):2304-7
7526001
N Engl J Med. 1987 Oct 8;317(15):909-16
2442609
JAMA. 1995 Feb 15;273(7):548-52
7530782
J Urol. 2002 Nov;168(5):2108-10
12394720
Urology. 2002 Jul;60(1):93-7
12100931
Prostate. 1999 May 15;39(3):198-204
10334109
J Urol. 1989 Jul;142(1):71-4; discussion 74-5
2659827
J Urol. 1998 Mar;159(3):920-4
9474183
JAMA. 1984 Dec 21;252(23):3261-4
6512929
Urol Clin North Am. 1989 Nov;16(4):675-91
2683298
J Urol. 1996 Feb;155(2):441-3
8558630
Curr Urol Rep. 2004 Jun;5(3):226-30
15161572
J Urol. 1991 May;145(5):907-23
1707989
Prostate. 1985;7(2):117-29
2413429
JAMA. 1993 Aug 25;270(8):948-54
7688438
J Urol. 1989 Oct;142(4):1008-10
2677409
J Urol. 1990 Jun;143(6):1146-52; discussion 1152-4
1692885
Cancer. 1996 Jan 1;77(1):150-9
8630923
J Urol. 1994 Nov;152(5 Pt 1):1506-9
7523707