An unbiased C-G Cl(c) (r) can be calculated using actual body weight in underweight patients and ideal body weight in patients of normal weight. Using ABW(0.4) for overweight, obese, and morbidly obese patients appears to be the least biased and most accurate method for calculating their C-G Cl(c) (r) . Rounding S(c) (r) in patients with low S(c) (r) did not improve accuracy or bias of the Cl(cr) calculations.

Transition zone biopsies have been found to increase the detection rates of cancer of the prostate in patients with negative digital rectal examination. There are however no data available whether the higher biopsy rate is associated with greater morbidity. The present study was therefore designed to evaluate the complication rate of extended sextant biopsy. In this prospective study, 162 consecutive patients who presented for prostatic evaluation were included. After starting prophylactic antibiotic treatment 48 h prior to the procedure, transrectal ultrasound-guided core biopsies were obtained from each lobe: three each from the peripheral zone (apex, mid-zone and base) and two from the transition zone of each prostatic lobe. In all patients a questionnaire was obtained 10–12 days after the procedure. Major complications occurred in 3 patients. In 2 of the 3 cases major macroscopic hematuria was treated by an indwelling catheter for 1 or 2 days and 1 patient developed fever >38.5°C for 1 day. Minor macroscopic hematuria was present in 68.5% of the patients. In 17.9% of these cases, the hematuria lasted for more than 3 days. Hematospermia was observed in 19.8% and minor rectal bleeding occurred in 4.9%. Ten-core biopsies did not lead to an increase in adverse effects or complications when compared to the results of sextant biopsies reported in the literature.

Background: Transrectal ultrasound is commonly performed in the clinical evaluation of the prostate. Ultrasound-guided randomized sextant biopsy became the standard procedure for the diagnosis of carcinoma of the prostate (CaP). A guided biopsy of sonographically irregular lesions of the prostate is not performed in randomized biopsies. An almost generally accepted opinion is that hypoechoic lesions are suspicious for the presence of CaP. However, the role of prostatic lesions with an echogenicity other than iso- or hypoechoic, e.g. hyperechoic or irregular lesions in relation to CaP is not clear. The intention of the present prospective study was to clarify the role of different prostatic ultrasound findings with a new-generation ultrasound probe in regard to their relevance concerning the presence of cancer. Material and Methods: 265 patients who were referred for prostatic evaluation because of an elevated PSA serum level or a positive digital rectal examination were enrolled in a prospective study. All patients had a systematic ultrasound-guided sextant biopsy of the prostate and a 4-core biopsy of the transition zone. All biopsy cores taken were guided by transrectal ultrasound. In case of a sonographically suspicious lesion, biopsy was always directed into this area. The predominant ultrasound appearance was separately recorded for each core. Results: Carcinoma of the prostate was detected in 87 (32.8%) of the 265 patients. Biopsy cores with isoechoic ultrasound findings revealed CaP in 7.6%. The data for hypoechoic, hyperechoic, mixed-echoic and anechoic lesions were 34.5, 26.9, 21.1 and 0%, respectively. Hypoechoic ultrasound findings were less frequently found in the transition zone of the prostate, but the rate of CaP detection was the same as in the peripheral zone of the prostate. Conclusions:The transrectal ultrasound pattern of the prostate yields important information about the presence of carcinoma of the prostate. Especially hypoechoic lesions indicate the presence of CaP in a significant proportion of cases. However, hyperechoic lesions and lesions of mixed or irregular echogenicity were found to contain cancer in significant numbers as well, and should therefore be considered to be suspicious for cancer when performing transrectal ultrasound of the prostate. Directed biopsy of irregular ultrasound patterns in the prostate seems therefore to be recommendable.

ZusammenfassungEinleitung: Ziel war die Untersuchung der Wertigkeit von 4 zusätzlichen Transitionalzonenbiopsien bei Patienten, die sich bei Verdacht auf das Vorliegen eines Prostatakarzinoms einer ultraschallgesteuerten Sextantenbiopsie der Prostata unterzogen. Patienten und Methoden: 324 Patienten mit dem Verdacht auf das Vorliegen eines Prostatakarzinoms (PSA ³ 4 ng/ml: n = 287; abnormer rektaler Tastbefund: n = 127) wurden prospektiv untersucht. 170 Patienten hatten zuvor bereits eine oder mehrere negative Biopsien. Neben den üblichen Sextantenbiopsien wurden in jedem Seitenlappen 2 zusätzliche Biopsien aus der Transitionalzone entnommen. Ergebnisse: Bei 110/324 Patienten wurde ein Prostatakarzinom nachgewiesen. Bei 10 dieser 110 Patienten waren ausschlieûlich Biopsien der Transitionalzone positiv, während 32 Patienten ausschlieûlich in Biopsien der peripheren Zone und 68 Patienten in beiden Zonen Tumorgewebe aufwiesen. Ausschlieûlich in der Transitionalzone positive Biopsien wurden relativ häufig bei T1c-Tumoren (7/10) und im PSA-Bereich zwischen 4 und 10 ng/ ml (7/10) gefunden. Bei Patienten mit vorangegangenen negativen Biopsien waren die gesamte Tumordetektionsrate (32,9 % vs. 35,1 %) und die Detektionsrate von nur in der Transitionalzone nachweisbaren Karzinomen (2,4 % vs. 3,9 %) ähnlich wie bei den nicht vorbiopsierten Patienten. Schlussfolgerung: Eine Entnahme von 4 zusätzlichen Transitionalzonenbiopsien erhöht die Tumordetektionsrate insgesamt nur marginal. Ausschlieûlich in der Transitionalzone positive Biopsien wurden vorwiegend bei nicht tastbaren Tumoren und im PSA-Bereich zwischen 4 und 10 ng/ml beobachtet.