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2004, Number 3

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Anales de Radiología México 2004; 3 (3)

Prostatic Biopsy guided by transrectal ultrasound: Experience in 9 years with 2,016 patients

Saavedra AJ, Stoopen ME, Barois BV, Sánchez HR

Language: Spanish
References: 22
Page: 181-189
PDF size: 659.04 Kb.


ABSTRACT

Objective: The purpose of this study is to show our experience in the detection of prostate cancer with the use of transrectal ultrasound-guided (TRUS) biopsy in 2.016 patients, in a 9-year period.

Material and Methods: Twothousand sixteen patients were selected, purpose of this study, who had the complete data of the rectal digital exam, PSA and result of the biopsy. The studies were carried out with commercial high resolution ultrasound (US) equipment. The Positive Predictive Value (PPV) of the TRUS alone was calculated, taking into account only the number of patients with a positive TRUS and biopsy, the PPV and Negative Predictive Value (NPV) were also calculated for the TRUS in combination with the PSA.

Results: Of the 2,016 biopsies, 746 were positive for prostate cancer (37%). The location of the cancers was in the peripheral zone in 560 patients (75%), 164 in the transition zone (22%), and 22 in the central zone (3%). The echogenicity of the neoplasm was distributed as follows: 477 were hypoechoic (64%), 187 isoechoic (25%), 60 had mixed echogenicity (8%) and 22 were hyperechoic (3%). There were minor and transitory incidents in 1.299 patients: 423 cases (21 %) had rectal bleeding, 463 patients (23%) had hematuria, and 443 cases (22%) had hemospermia. We consider a major complication infection which occurred in 44 patients (2.2%). The TRUS was positive in 1.108 patients (55%), the rectal digital exam in 1.008 patients (50%) and the PSA in 1.512 (75%). The PPV for the TRUS alone was 54 % and in combination with the rectal digital exam it went up to 62%. The NPV for the TRUS according with the rectal digital exam descended to 48. The PPV for the TRUS when the PSA was abnormal (positive) was 72% and the NPV (normal antigen) was 22%.

Conclusions: In our study a negative PSA resulted in 22% risk for cancer. Our results show that the finding of an abnormal TRUS results in a 54% risk for cancer and biopsy is indicated in these cases. If the rectal digital exam is negative it does not exclude a risk for cancer. Only when the rectal digital exam is negative and the PSA values are normal, it is possible to define a group of patients with TRUS in whom a biopsy is not indicated. We conclude that: a) based on TRUS alone, finding an abnormality is an indication for a biopsy, b) finding an al abnormality in the TRUS, rectal digital exam and an elevation in PSA, the patient has a high risk for cancer and a biopsy is imperative.


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