Abstract
We present our experience with a new technique of real time 3-dimensional sonography—“4-dimensional Transrectal ultrasound (TRUS)” guided prostate biopsy. A total of 64 patients suspected of having prostate cancer based on an elevated prostate-specific antigen (greater than 4 ng/ml) formed the study group. A voluson (General Electric Vivid 3) ultrasound machine equipped with a transrectal 5–8 MHz curvilinear transducer was used. Sonography-guided prostate biopsy was performed following prostate imaging and volume calculation using 3D and 4D imaging. Biopsies of tumor suspicious areas, if present, as well as random biopsies were done. Histopathology showed prostate cancer in 15 (23.4%) and benign prostatic conditions in 49 (76.6%). TRUS examination in the 15 detected prostatic cancers showed that 6(40%) were hypoechoic, 4 (26.7%) were of mixed hypo and hyper echogenicity, 1 (6.7%) was hyperechoic, and 4 (26.7%) were isoechoic. TRUS finding of a hypoechoic lesion was significantly associated with malignancy. Other TRUS findings such as texture, calcification, and cysts did not show any association with malignancy. Mortality was zero after ultrasound-guided prostate biopsy. TRUS is the diagnostic test of choice in detection of prostate cancer. With advances in the technique of TRUS, effort is being made to identify more subtle lesions in order to reduce random biopsies. 4-Dimensional TRUS does improve the diagnostic accuracy but there is still a group of patients with “invisible” cancers. Therefore, the policy of random biopsies has to be continued till this incidence can be eliminated.
Similar content being viewed by others
References
Troyer DA, Mubiru J, Leach RJ et al (2004) Promise and challenge: markers of prostate cancer detection, diagnosis and prognosis. Dis Markers 20:117–128
Kataja VV (2003) ESMO Guidelines. Task force ESMO minimum clinical recommendations for diagnosis, treatment and follow-up of prostate cancer. Ann Oncol 14:1010–1011
Cheon J, Kim CS, Lee ES et al (2002) Survey of incidence of urological cancer in South Korea: a 15-year summary. Int J Urol 9:445–454
Hernandez J, Thompson IM (2004) Prostate-specific antigen: a review of the validation of the most commonly used cancer biomarker. Cancer 101:894–904
Watanabe H, Igari D, Tanahashi Y et al (1975) Transrectal ultrasonography of the prostate. J Urol 114:734–739
Loch T, McNeal JE, Stamey TA (1995) Interpretation of bilateral positive needle biopsies in prostate cancer. J Urol 154:1078–1083
Perrin P, Maquet JH, Bringeon G et al (1991) Screening for prostate cancer: comparison of transrectal ultrasound, prostate-specific antigen and rectal examination. Br J Urol 68:263–265
Drago JR, York JP (1992) Prostate-specific antigen, digital rectal examination, and transrectal ultrasound in predicting the probability of prostate cancer. J Surg Oncol 49(3):172–175
Lee F, Littrup PJ, Torp-Pedersen ST et al (1988) Prostate cancer: comparison of transrectal US, and digital rectal examination for screening. Radiology 168:389–394
Gustafsson O, Norming U, Almgard LE et al (1992) Diagnostic methods in the detection of prostate cancer: a study of randomly selected population of 2,400 men. J Urol 148:1827–1831
Potter SR, Horniger W, Tinzl M et al (2001) Age, prostate-specific antigen, and digital rectal examination as determinants of the probability of having prostate cancer. Urology 57(6):1100–1104
Vallancien G, Prapotnich D, Veillon B (1991) Systematic prostate biopsies in 100 men with no suspicion of prostate cancer on digital rectal examination. J Urol 146(5):1308–1312
Rifkin MD, Zerhouni EA, Gatsonis CA et al (1990) Comparison of magnetic resonance imaging and ultrasonography in staging early prostate cancer. N Engl JMed 323:621–626
Flanigan RC, Catalona WJ, Ritchie JP et al (1994) Accuracy of digital rectal examination and transrectal ultrasonography in localizing prostate cancer. J Urol 152:1506–1509
Vo TDO, Rifkin MD, Peters TL (2001) Should ultrasound criteria of the prostate be redefined to better evaluate when and where to biopsy? Ultrasound Quaterly 17(3):171–176
Rifkin MD, Choi H (1988) Implications of small peripheral hypoechoic lesions in endorectal US of the prostate. Radiology 166:619
Tang J, Li X, Wang N et al (2005) Correlation between hypoechoic nodules on ultrasonography and benign hyperplasia in the prostate outer gland. J Ultrasound Med 24:483–488
Oyen RH, Van de Voorde WM, Van Poppel HP et al (1993) Benign hyperplastic nodules that originate in the peripheral zone of the prostate gland. Radiology 189:707–711
Loch T, Eppelemann U, Lehmann J et al (2004) Transrectal ultrasound guided biopsy of the prostate: random sextant versus biopsies of sono-morphologically suspicious lesions. World J Urol 22:357–360
Ellis WJ, Brawer MK (1994) The significance of isoechoic prostatic carcinoma. J Urol 152:2304–2307
Al-Ghazo MA, Ghalayini IF, Matalka II (2005) Ultrasound-guided transrectal extended prostate biopsy: a prospective study. Asian J Androl 7(2):165–169
Fleshner N, Klotz L (2002) Role of ‘saturation biopsy’ in the detection of prostate cancer among difficult diagnostic cases. Urology 60:93–97
Hodge KK, McNeal JE, Terris MK et al (1989) Random systematic versus directed ultrasound guided transrectal biopsies of the prostate. J Urol 142:71–75
Gupta NP, Ansari MS, Dass SC (2005) Transrectal ultrasound guided biopsy for detecting early prostate cancer: an Indian experience. Indian J Cancer 42(3):151–154
Fink KG, Hutarew G, Pytel A et al (2003) One 10-core prostate biopsy is superior to two sets of sextant prostate biopsies. BJU Int 92:385–388
Naughton CK, Miller DC, Mager DE et al (2000) A prospective randomized trial comparing 6 versus 12 prostate biopsy cores: impact on cancer detection. J Urol 164(2):388–392
Rodriguez RP, Dehesa TM, Gonzalez AM et al (2005) Results of a series of transrectal ultrasound guided biopsy of the prostate in 6000 patients. Part I. Pathology, digital rectal examination, transrectal ultrasound, and PSA. Arch Esp Urol 58(7):611–622
Miyake H, Kurahashi T, Murmaki M et al (2005) Significance of routine transitional zone biopsies in Japanese men undergoing transrectal ultrasound-guided biopsies. Intl J Urol 12(11):964–968
Purohit RS, Shinohara K, Meng MV et al (2003) Imaging clinically localized prostate cancer. Urol Clin N Am 30:279–293
Mehta SS, Azzouzi AR, Hamdy FC (2004) Three dimensional ultrasound and prostate cancer. World J Urol 22:339–345
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Abul, F., Arun, N., Abu-Assi, M. et al. Transrectal ultrasound guided biopsy for detecting prostate cancer: can random biopsies be reduced using the 4-dimensional technique?. Int Urol Nephrol 39, 517–524 (2007). https://doi.org/10.1007/s11255-006-9060-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-006-9060-2