title: Histologic confirmation of a biochemical recurrence after radical prostatectomy by performing 3-dimensional transrectal ultrasonography-guided biopsy with fusion to magnetic resonance imaging.
abstract: OBJECTIVE
  To obtain a histologic confirmation of biochemical recurrence after radical prostatectomy, which still remains a challenge. Historically, biopsy protocols have been designed but have provided rather unsatisfactory results. We report the first case of histologic confirmation of a biochemical recurrence in the prostatectomy bed by performing 3-dimensional transrectal ultrasonography-guided biopsy with fusion to magnetic resonance images.
  
  
  METHODS
  A 66-year-old man who underwent laparoscopic prostatectomy for a localized prostate cancer of Gleason sum 3+3=6 and preoperative prostate-specific antigen (PSA) level of 8.9 ng/L was followed up yearly. Postoperative serum PSA value was <0.04 ng/L. Nine years later, the patient developed a biochemical recurrence with an elevation of serum PSA level to 1.27 ng/mL. A 3-T endorectal positron emission tomography-magnetic resonance imaging (MRI) scan showed a 5 × 3 mm nodule in the prostatectomy bed in contact with the vesicourethral anastomosis without hypermetabolism. Two biopsies of this nodule were performed by using a 3-dimensional endorectal ultrasonography probe connected to the Koelis navigation system (Urostation; Koelis, Grenoble, France) with fusion to MRI images.
  
  
  RESULTS
  Histologic findings confirmed the presence of a recurrence of the prostate cancer of Gleason sum 4+3=7 in both biopsies, and the patient was addressed to the radio-oncologist for salvage therapy.
  
  
  CONCLUSIONS
  The use of a transrectal approach with 3-dimensional guidance and MRI fusion allows correct sampling of prostate cancer recurrence nodules in the prostate bed. This procedure is easily performed in the outpatient clinic but still has to be validated in a larger series.
authors.affiliation: Division of Urologic Surgery, Geneva University Hospital, Geneva, Switzerland. Electronic address: jacques.klein@hcuge.ch.
authors.forename: Jacques
authors.initials: J
authors.lastname: Klein
authors.affiliation: Division of Urologic Surgery, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Benamran
authors.affiliation: Department of Radiology, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Vallee
authors.affiliation: Division of Urologic Surgery, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Christophe E
authors.initials: CE
authors.lastname: Iselin
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D060787:Neoplasm Grading; D016133:Polymerase Chain Reaction; D049268:Positron-Emission Tomography; D011467:Prostate / Q000000981:diagnostic imaging / Q000601:surgery*; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D014463:Ultrasonography
chemical_list: D017430:Prostate-Specific Antigen