Abstract:

Purpose: To overview transrectal ultrasonography (TRUS) guided prostate biopsy cases and to evaluate the potentially useful sonographic criteria for the diagnosis of prostate cancer. Methods:Between January 2003 and June 2005, TRUS guided prostate biopsy specimens were obtained from 129 patients with a gray zone PSA level (4 - 10 ng/dl; average PSA: 6.9 ± 2.7 ng/dl). TRUS findings were compared with pathology results. Peripheral zone echostructure (homogenous or heterogeneous) and prostate contours (smooth or irregular) were classified subjectively. Presence of a hypoechoic nodule in the peripheral zone was noted, additional samples were obtained from the nodules. Results: 44 patients (34%) were found to have prostate adenocarcinoma. A statistically significant relationship was found between the peripheral zone echostructure - presence of hypoechoic nodule in the peripheral zone and pathological results (p=0.000 and 0.007, respectively). Prostate cancer detection rate increased 7 folds [Odds Ratio (OR): 7.06 (2.98-16.70) 95% Confidence Interval (CI)] when the peripheral zone was heterogeneous and 3 folds [OR: 2.73 (1.18-6.28) 95% CI] when there was a hypoechoic nodule in the peripheral zone. Conclusion:TRUS has a limited role in the diagnosis of prostate cancer and is especially used for biopsy guidance. On the other hand, the results of this study reveal a significant increase in cancer detection rate when the mentioned TRUS findings are present. Similar to the nodule targeted biopsies; the accuracy of the presented study can be evaluated with a prospective study including a larger number of biopsy specimens in case of peripheral zone heterogenity.

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