The importance of tumor palpability and transrectal ultrasonographic appearance in the contemporary clinical staging of prostate cancer.
BACKGROUND
An accurate assessment of the clinical stage of prostate cancer is important to determine the most appropriate treatments for patients. Most centers rely on digital rectal examination, given conflicting results in the literature regarding the role of transrectal ultrasonography (TRUS).


OBJECTIVE
Since ultrasound technologies as well as physician experience have improved, the contemporary impact of TRUS on the clinical staging of prostate cancer was assessed.


METHODS
In 2002, a standardized form to evaluate TRUS findings in order to rank the clinical suspicion of extracapsular extension (ECE) was used for all prostate cancer patients evaluated at UCSF. Preoperative clinical findings were compared with pathological staging as assessed by analysis of radical prostatectomy specimens from 2002 to 2007 (n = 620).


RESULTS
Mean patient age was 58 ± 6.6 years with a mean PSA of 7.0 ± 4.5; 157/620 (25.3%) had pathologic ECE. Evidence of ECE by TRUS was associated with higher pathologic stage (P < 0.00001) and higher rates of biochemical failure after prostatectomy (P = 0.0006). Overall, TRUS had a 31% sensitivity, 92% specificity, 58% positive predictive value, and 80% negative predictive value with an area under the curve of 0.77 for the detection of ECE. TRUS alone was significantly more accurate in predicting ECE than commonly used nomograms or tables (P < 0.001) when examining patients with impalpable tumors.


CONCLUSIONS
In the current era, TRUS provides an accurate method to assess a cancer stage.
Eisenberg
Michael L
ML
Department of Urology, University of California, San Francisco, Hellen Diller Family Comprehensive Cancer Center, San Francisco, CA 94143, USA. meisenberg@urology.ucsf.edu
Cowan
Janet E
JE
Davies
Benjamin J
BJ
Carroll
Peter R
PR
Shinohara
Katsuto
K
D000368:Aged; D051517:Digital Rectal Examination / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011467:Prostate / Q000473:pathology / Q000601:surgery; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000601:surgery; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D047368:Tumor Burden; D014463:Ultrasonography / Q000379:methods*