Prostate ultrasound and biopsy in the detection of prostate carcinoma

Prostate cancer is the most common cancer in men, excluding skin cancer. Globally, it is the sixth leading cause of cancer-related death in men, and the second one in the United States 1. Rates of prostate cancer detection vary widely across the world, but the highest rates occur in the developed countries. Since the introduction of the prostate-specific antigen (PSA) as screening method, the early diagnosis of prostate cancer through prostate biopsy has become a real fact. Even if ultrasound-guided random prostate biopsy is the method used in our practise for the early detection of prostate adenocarcinoma, differences exist in detection rates of positive cases between different operators, as well as in the number of samples obtained in each procedure and the usefulness of focal lesions sampling visualized by transrectal ultrasound 2. The objective of this retrospective study is to show our experience in this procedure, highlighting the aforementioned issues. Abstract Purpose: To show our experience in prostatic transrectal ultrasound and transrectal ultrasound-guided biopsy over a tenyear period by a retrospective analysis in order to determine the detection rate of adenocarcinoma, to identify the distribution of positive samples in the gland, and to evaluate the usefulness of biopsy of nodules seen on imaging studies. Materials and methods: A total of 1163 ultrasound and ultrasound-guided transrectal prostate biopsies were performed between March 2001 and November 2011. The population sample included patients who had undergone more than one biopsy. Data obtained from these procedures enables us to identify three age groups according to the incidence of pathology, to determine the most frequent location of adenocarcinoma within the prostate, and to evaluate the usefulness of prostate nodules biopsy in the detection of adenocarcinoma. Results: Analysis of the data has shown a 16% detection rate of adenocarcinoma in men under 50 years of age, 36% in patients between 50 and 65 years, and 48% in patients older than 65 years. The left base of the prostate had the highest detection rate (15%), followed by left medium (14%), right base (14%), right medium (13%), left apex (12%), left lateral medium (12%), right apex (11%) and right lateral medium (10%). Nodular images were found in 299 patients: 118 were positive for adenocarcinoma (Group A) and 181 were negative (Group B). Group A was divided into 3 subgroups: Subgroup A, with a positive result only in the nodule sample, and a negative result in the rest of the gland sample; Subgroup B, with a positive result in the gland samples but negative in the nodule sample; and Subgroup C, with results that were positive both in the gland and nodule samples. Conclusion: Ultrasound and ultrasound-guided transrectal prostate biopsy play an important role in the evaluation of the prostate when adenocarcinoma is suspected. Based on our experience, ultrasound-guided prostate biopsy is the most useful method for the detection of adenocarcinoma, especially in patients over 65 years of age, and the nodule sample (if any) should be included in the eight-biopsy scheme. © 2012 Sociedad Argentina de Radiología. Published by Elsevier España, S.L. All rights reserved.