Journals / Türk Üroloji Dergisi/Turkish Journal of Urology / 2004 / Cilt: 30 - Sayı: 2
The value of transrectal ultrasonography for detecting prostate cancer in patients with PSA levels less than 4.0 ng/ml
- Pages
- 155–159
- DOI
- —
Abstract
Introduction: Prostate specific antigen (PSA) has been widely used in screening studies for prostate cancer and PSA levels higher than 4 ng/ml are accepted suspicious for prostate cancer. But some studies have showed that 5-20% of the patients who had undergone prostate biopsy with PSA levels below 4.0 ng/ml had also prostate cancer. For these patients, it is not clear that which sonographic findings should necessitate biopsy. The aim of our study was to evaluate the transrectal ultrasonography (TRUS) findings in patients with PSA levels <4.0 ng/ml and compare these with histopathologic results in order to point out which sonographic findings may help for detecting prostate cancer in these patients. Materials and Methods: Between 1995 and 2002, the charts of 27 patients who had undergone prostate biopsy with PSA levels below 4.0 ng/ml were retrospectively reviewed and TRUS findings of these patients were evaluated. TRUS and TRUS guided prostate biopsies have been performed using a biplane (7 MHz lineer, 6 MHz end fire) transrectal probe. Biopsies have been taken with a 18 G – 21 cm long automatic biopsy needle. Sextant or 8 cores biopsy system was used and additional biopsies were taken from suspicious lesions defined by TRUS. Results: Of these 27 patients who had undergone biopsy, 20 (74.1%) patients had benign disease and 7 (25.9%) had prostate cancer. Mean PSA value was 2.38 ng/ml for the benign group and 2.52 ng/ml for the patients with prostate cancer. TRUS findings in the benign group were hypoechoic nodule in 65% of the patients and regional hypoechogenicity in 35% of the patients. In this group, 11 of the patients were diagnosed as having normal prostate tissue or benign prostatic hyperplasia, 6 patients as prostatitis and 3 patients as prostatic intraepithelial neoplasia (PIN) histopathologically. The PIN foci were defined as low grade PIN and repeat biopsies did not reveal any prostate cancer, so these patients have been included in the benign group. TRUS findings in prostate cancer group were hypoechoic nodule in 5 patients (71.4%), regional hypoechogenicity in 1 patient (14.3%) and heterogenous echogenicity pattern in 1 patient (14.3%). In the whole study group, prostate cancer has been detected in 5 of the 18 (27.7%) nodules and in 1 of the 8 (12.5%) regional hypoechogenicity areas. Only one patient with heterogenous pattern was diagnosed as prostate cancer. Conclusion: TRUS may be helpful for detecting prostate cancer in patients with normal PSA levels and the most common findings in this group are peripheral zone nodules and heterogenous echogenicity pattern of peripheral zone.
Özet
Çalışmamızda 4.0 ng/ml altındaki PSA değerine sahip olguların TRUS bulgularını değerlendirip, bunları histopatolojik sonuçlarla karşılaştırarak, bu hastalarda hangi sonografik bulguların prostat kanserine işaret edebileceğini belirlemeyi amaçladık. 1995-2002 yılları arasında PSA düzeyi 4.0 ng/ml’den az olan, anormal TRUS bulgusu nedeniyle prostat biyopsisi yapılan 27 hastanın, biyopsi ve TRUS sonuçları retrospektif olarak incelenmiş ve biyopsi yapılmasına yönelten TRUS bulguları değerlendirilmiştir. Çalışma grubunu oluşturan 27 olgudan; biyopsi sonucu benin gelenlerin sayısı 20 olup, prostat kanseri saptanan olgu sayısı 7’dir. Prostat kanseri saptanan grupta biyopsiye yönelten TRUS bulguları: 5 (%71.4) olguda hipoekoik nodül, 1 (%14.28) olguda bölgesel ekojenisite düşüklüğü, 1 (%14.28) olguda ise heterojen eko paterniydi. Tüm çalışma grubunda biyopsi alınmasına yönlendiren bulgular göz önüne alındığında tanımlanan 18 adet nodülden 5’inde (%27.7), 8 adet bölgesel ekojenisite düşüklüğünden 1’inde (%12.5) prostat kanseri saptanmıştır.TRUS normal PSA düzeyli erkeklerde prostat kanseri saptanmasına yardımcı olabilir ve bu grupta en önemli TRUS bulguları periferik zon nodülleri ile periferik zonda heterojen eko paternidir. Ancak, %75’lere varan benin sonuçlu gereksiz biyopsilerin sayılarının azaltılması için, daha geniş olgu sayılı çalışmalar ve diğer tanısal kriterlerle birliktelik (korelasyon) gereklidir.