Value of Hypoechoic Lesions in the Diagnosis of Prostate Cancer with Transrectai Ultrasonographically Guided Biopsies

Kim, Ki Young; Park, Hay Young

Abstract

We studied the efficacy of directed and random, transrectal sonographically guided biopsies in the diagnosis of prostatic carcinoma. Between January 1994 and June 1995, 33 men underwent transrectal sonographically guided biopsies of the prostate because they had clinical findings suggestive of prostatic carcinoma. Such findings included abnormal results on digital rectal examination and elevated levels of prostate-specific antigen. Of the 33 patients evaluated sonographically, 18 had hypoechoic lesions and 1S had no hypoechoic lesions. Of the 18 patients with a hypoechoic lesion, biopsy results were positive for carcinoma in 7 patients (35%). Of the 15 patients with no hypoechoic lesion, biopsy results were positive for carcinoma in 3 patients (20%). Of the 18 patients with a hypoechoic lesion, 16 had a hypoechoic lesion in the peripheral zone and 2 had a hypoechoic lesion in the transition zone. Of the 16 patients with a hypoechoic lesion in the peripheral zone, biopsy results were positive for carcinoma in 6 patients. Of the 2 patients with hypoechoic lesion in transition zone, biopsy results were positive for carcinoma in 1 patient. While 47% of patients with abnormal DRE findings and elevated PSA level had prostatic cancer, 13% of patients with biopsy-proved cancer had normal DRE findings and elevated PSA level. Of the 12 patients, 7 patients with biopsy-proved cancer had abnormal DRE findings, elevated PSA level and abnormal TRUS. The author conclude, therefore, that in` suspicious patients, sonographically guided transrectal biopsies of hypoechoic lesions may not be reliable as the sole method of detecting prostatic carcinoma. The yield of carcinoma detection increase significantly when random biopsies are performed in patients in which lesions are not found on transrectal sonograms. The optimal biopsy technique includes a transrectal sonographically guided core through any hypoechoic lesion in the nperipheral zone followed by bilateral segmental random biopsies.