Radical prostatectomy: transrectal sonographic evaluation to assess for local recurrence.

Abstract

Sonographic visualization of a mass in the prostate bed or loss of integrity of the retroanastomotic fat plane is strongly correlated with finding recurrent or residual tumor in this location. TRUS in evaluation of the source of postoperative evaluation of prostate-specific antigen levels warrants further investigation.

Value of Immediate Anastomotic Biopsy following Biochemical Failure after Radical Prostatectomy

“…Despite the fact that residual benign prostate tissue may contribute to PSA relapse and the theoretical possibility of its malignant transformation, benign positive margins in radical prostatectomy specimens are usually still unreported. The percentage of residual prostate tissue (both benign and malignant) in our study is similar to those previously reported for malignant tissue only, ranging from 45 to 55%, while local benign prostate tissue is reported by fewer authors [7,12,24] . This discrepancy may either suggest the possibility of transformation or may only reflect lower PSA relapse levels and exclusion criteria in our study in distinction to other studies.…”

“…One could argue that PSA, being a marker of proven specificity, may render the need for confirmation by biopsy unnecessary. Also, previous work has questioned the influence of the histological proof of cancer recurrence on the outcome of radiation therapy following radical prostatectomy [18,19] , yet to our knowledge previous work assessing the anastomotic biopsy issue [7][8][9][10][11][12]18] is also indifferent to the time interval between the diagnosis of PSA relapse and biopsy session.…”

“…Previous studies have addressed the application of transrectal ultrasound (TRUS) and TRUS-guided biopsies from the anastomotic area in cases presenting with BF after radical prostatectomy [7][8][9][10][11][12] . In distinction to previous studies, our study tried to evaluate the impact of the procedure when performed immediately after diagnosing BF.…”

Postradical prostatectomy TRUS-guided anastomotic biopsy. Where do we stand today?

“…In a similar early study by Salomon et al, 24 in a group of 21 patients, sonographic detection of a mass at the vesicourethral anastomosis or in the perianastomotic region had a strong correlation with obtaining positive perianastomotic biopsy results. This observation agrees with that of Foster et al 25 They also comment that the thickness of the anterior and posterior anastomotic soft tissues and the contour of the anterior bladder neck were not important factors in predicting biopsy results, in agreement to previous studies.…”

“…Discrete masses are commonly described in cases with biochemical failure. 18,20,21,24 Also, lack of integrity of the echogenic retroanastomotic plane may be a secondary indicator of local recurrence, since this finding correlated well with histology detection of perianastomotic tumour, 24 but there were no specific attempts to sample correlation with TRUS-detected masses. The nonspecificity of the changes in the perianastomotic region is a not suprising phenomenon especially if fibrotic postoperation tissue is accounted for this appearance, irrelevantly of the possibility of local recurrence (Figures 1-3).…”