Transrectal ultrasound guided biopsy of the prostate: random sextant versus biopsies of sono-morphologically suspicious lesions

Abstract

Transrectal ultrasound (TRUS) guided multiple systematic random biopsies are presently the method of choice for determining the presence or absence of prostate cancer. TRUS image information is only used to guide the biopsy needle into the prostate, but not to localize and target cancerous lesions. Our aim in this study was to evaluated the possible predictive value of tumor suspicious endosonographic lesions of the prostate for prostate biopsies. We prospectively compared six systematic biopsies with lesion guided biopsies in a consecutive series of 217 patients. All patients had a prostate specific antigen (PSA) level of >4 ng/ml without a history of prostate disease. In a subgroup of 145 men with sonomorphologic lesions suggestive for prostate cancer (hypoechoic areas or asymmetries predominantly in the peripheral zone), lesion-guided biopsies were taken in addition to the systematic biopsies. We evaluated the number of tumors which were diagnosed or missed by both of the biopsy strategies. Of the 217 evaluated patients, 64 (29%) had histology confirmed cancer. Four patients with negative sextant biopsies had a positive TRUS guided biopsy. Out of 145 patients with a normal TRUS, three were cancer positive by sextant biopsy. A total of 1,387 individual biopsy cores were evaluated. Of the 1,304 systematic biopsy cores, 182 (14%) were positive and 1,122 (86%) negative. Of the 329 TRUS lesion guided biopsy cores 139 (42%) were positive and 190 (58%) negative. Patients with tumor suggestive TRUS lesions have a considerably higher risk of being diagnosed with prostate cancer compared to patients without such lesions. Both systematic sextant and TRUS lesion guided biopsies missed detectable prostate cancer in a minority of patients. Taking the endosonographic morphology of the prostate gland into consideration for biopsy strategies may improve the quality of the biopsy and avoid unnecessary invasive procedures in selected cases.

The Incidence of Hyperechoic Prostate Cancer in Transrectal Ultrasound–Guided Biopsy Specimens

“…The patients included in their study had no limited PSA value. In our study, all patients had PSA <20, and we diagnosed a higher percentage of prostate cancers compared to Loch et al 7 The higher percentage of cancer detected in our study could probably be ascribed to additional biopsies that were obtained in hyperechoic lesions, where another five carcinomas were identified.…”

“…24 , where median PSA value was higher than that recorded in our study (13.2 vs. 9.9 ng/mL). Loch et al 7 report on a 29% rate of prostate cancer in patients with PSA >4. The patients included in their study had no limited PSA value.…”

“…Besides having a major role in positioning the needle trajectory for prostate biopsy, TRUS enables visualization of focal lesions suspected of prostate cancer. [4][5][6][7][8] A definitive protocol regarding the number of biopsy cores for prostate biopsy has not yet been established, and the number of cores taken per biopsy varies from 4 to 30. [9][10][11] Recently, the average number of biopsies has been gradually increasing, however, the detection rate remains unchanged and the need of repeat biopsy is increasing.…”

Transrectal contrast enhanced ultrasound for diagnosis of prostate cancer

“…Adding targeted biopsies in patients with visible lesions on B-mode TRUS to a random biopsy protocol might increase sensitivity for detection of prostate cancer [37]. Colour and power Doppler techniques increase the sensitivity of TRUS, but cannot avoid the necessity of random biopsies [24,33].…”

Doppler Spectral Waveform Parameters at Neurovascular Bundle Vessels in Patients with Prostate Biopsy

“…Several researchers have attempted to develop some innovative imaging techniques to improve prostate cancer detection, such as Doppler-related techniques, [3][4][5][6][7] ultrasonic elastography, 8 and magnetic resonance imaging of the prostate. 9 Doppler techniques have been applied in perfusion studies of the prostate gland for the last two decades.…”