Korean J Urol.  2006 Jul;47(7):752-756. 10.4111/kju.2006.47.7.752.

The Diagnostic Significance of Abnormal Findings on Transrectal Ultrasonography in Patients with Serum Prostate-Specific Antigen Levels Equal or Less than 4.0ng/ml

• Lee SW
• Byun SS
• Lee SE

• KMID: 2294317
• DOI: http://doi.org/10.4111/kju.2006.47.7.752

Abstract

PURPOSE: We evaluated the diagnostic significance of abnormal findings on transrectal ultrasonography (TRUS) in men with prostate-specific antigen (PSA) levels of 4.0ng/ml or less, presented with lower urinary tract symptoms.
MATERIALS AND METHODS
A total of 201 men with PSA levels of 4.0ng/ml or less underwent prostate biopsy with 12 cores. The indications for a biopsy were an elevated PSA of 3.0ng/ml or more, abnormality on digital rectal examination (DRE) and/or focal lesion on TRUS. Cancer detection rates according to TRUS and DRE findings, stratified by PSA level were investigated. Especially, the detection rates in patients who underwent prostate biopsies due to only abnormal findings on TRUS (only TRUS group) were addressed.
RESULTS
Of the 201 patients, 45 patients (22.4%) were diagnosed as having prostate cancer. The detection rate was 4.8% (1/21), 4.8% (1/21), 38.1% (8/21), and 25.4% (35/138) in patients with PSA levels of less than 1.0ng/ ml, 1.0 to 1.9ng/ml, 2.0 to 2.9ng/ml, and 3.0 to 4.0ng/ml, respectively. As for only TRUS group, the detection rate was 7.7% (2/26), 38.5% (5/13) and 21.7% (5/23) in patients with PSA levels of less than 2.0ng/ml, 2.0 to 2.9ng/ml, and 3.0 to 4.0ng/ml, respectively. For the patients with no abnormal findings on TRUS and DRE, and a PSA of 3.0 to 4.0ng/ml, the detection rate was 26.4% (24/91), and not significantly different from that of only TRUS group with a PSA of 3.0 to 4.0ng/ml.
CONCLUSIONS
It seems that prostate biopsy should be undertaken in patients with abnormal TRUS findings and PSA levels of 2.0 to 3.0ng/ml, and in all patients with PSA levels of 3.0 to 4.0ng/ml, irrespective of TRUS findings. In patients with abnormal TRUS findings and PSA levels of less than 2.0ng/ml, follow-up of PSA is recommended rather than performing immediate prostate biopsy.

Keyword

Biopsy; Diagnosis; Prostatic neoplasm; Prostate-specific antigen; Ultrasonography

MeSH Terms

Biopsy
Diagnosis
Digital Rectal Examination
Humans
Lower Urinary Tract Symptoms
Male
Prostate
Prostate-Specific Antigen*
Prostatic Neoplasms
Ultrasonography*
Prostate-Specific Antigen

Reference

1. Roehrborn CG, McConnell JD. Walsh PC, Retik AB, Vaughan ED, Wein AJ, editors. Etiology, pathophysiology, epidemiology and natural history of benign prostatic hyperplasia. Campbell's urology. 2002. 8th ed. Philadelphia: Saunders;1297–1330.

2. AUA Practice Guidelines Committee. AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: Diagnosis and treatment recommendations. J Urol. 2003. 170:530–534.

3. Matlaga BR, Eskew LA, McCullough DL. Prostate biopsy: indications and technique. J Urol. 2003. 169:12–19.

4. Terris MK. Walsh PC, Retik AB, Vaughan ED, Wein AJ, editors. Ultrasonography and biopsy of the prostate. Campbell's urology. 2002. 8th ed. Philadelphia: Saunders;3038–3054.

5. Ellis WJ, Chetner MP, Preston SD, Brawer MK. Diagnosis of prostatic carcinoma: the yield of serum prostate specific antigen, digital rectal examination and transrectal ultrasonography. J Urol. 1994. 152:1520–1525.

6. Flanigan RC, Catalona WJ, Richie JP, Ahmann FR, Hudson MA, Scardino PT, et al. Accuracy of digital rectal examination and transrectal ultrasonography in localizing prostate cancer. J Urol. 1994. 152:1506–1509.

7. Carter HB, Hamper UM, Sheth S, Sanders RC, Epstein JI, Walsh PC. Evaluation of transrectal ultrasound in the early detection of prostate cancer. J Urol. 1989. 142:1008–1010.

8. Colberg JW, Smith DS, Catalona WJ. Prevalence and pathological extent of prostate cancer in men with prostate specific antigen levels of 2.9 to 4.0ng/ml. J Urol. 1993. 149:507–509.

9. Schroeder FH, van der Cruijsen-Koeter I, de Koning HJ, Vis AN, Hoedemaeker RF, Kranse R. Prostate cancer detection at low prostate specific antigen. J Urol. 2000. 163:806–812.

10. Fowler JE Jr, Bigler SA, Farabaugh PB, Wilson SS. Prostate cancer detection in Black and White men with abnormal digital rectal examination and prostate specific antigen less than 4ng/ml. J Urol. 2000. 164:1961–1963.

11. Lodding P, Aus G, Bergdahl S, Frosing R, Lilja H, Pihl CG, et al. Characteristics of screening detected prostate cancer in men 50 to 66 years old with 3 to 4ng/ml prostate specific antigen. J Urol. 1998. 159:899–903.

12. Yamamoto T, Ito K, Ohi M, Kubota Y, Suzuki K, Fukabori Y, et al. Diagnostic significance of digital rectal examination and transrectal ultrasonography in men with prostate-specific antigen levels of 4ng/ml or less. Urology. 2001. 58:994–998.

13. Lee H, Lee KS. Value of hypoechoic lesion in transrectal ultrasonography for diagnosis of prostate cancer. Korean J Urol. 2000. 41:500–504.

14. Yoo SH, Kim SJ, Shin KY, Choi DY, Park HY, Lee TY, et al. Comparative study on diagnostic value of digital rectal examination, serum prostate specific antigen and transrectal ultrasound in prostate cancer. Korean J Urol. 1997. 38:1325–1332.

15. Kim JH, Park HJ, Kwon CH. Detection of prostate cancer by digital rectal examination, serum PSA and transrectal ultrasonography. Korean J Urol. 1998. 39:472–475.

16. Catalona WJ, Smith DS, Ratliff TL, Dodds KM, Coplen DE, Yuan JJ, et al. Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. N Engl J Med. 1991. 324:1156–1161.

17. Park HK, Hong SK, Byun SS, Lee SE. Comparison of the rate of detecting prostate cancer and the pathologic characteristics of the patients with a serum prostate-specific antigen level in the range of 3.0 to 4.0ng/ml and the patients with a serum PSA level in the range 4.1 to 10.0ng/ml. Korean J Urol. 2006. 47:358–361.

18. Catalona WJ, Ramos CG, Carvalhal GF, Yan Y. Lowering PSA cutoffs to enhance detection of curable prostate cancer. Urology. 2000. 55:791–795.

19. Kobayashi T, Nishizawa K, Ogura K, Mitsumori K, Ide Y. Detection of prostate cancer in men with prostate-specific antigen levels of 2.0 to 4.0ng/ml equivalent to that in men with 4.1 to 10.0ng/ml in a Japanese population. Urology. 2004. 63:727–731.