LOCAL RECURRENCE AFTER RADICAL PROSTATECTOMY - CHARACTERISTICS IN SIZE, LOCATION, AND RELATIONSHIP TO PROSTATE-SPECIFIC ANTIGEN AND SURGICAL MARGINS

Objectives. To define the sonographic characteristics of local cancer recurrence after radical prostatectomy. Methods. In 114 patients with an elevated prostate-specific antigen (PSA) and negative bone scan, 15 6 ultrasound-guided prostate fossa biopsies were carried out. Results. In 53.5%, biopsy proved local recurrence. More than one ultrasound-gu ided biopsy session was required to make the diagnosis in 33% of patie nts. Local recurrence was seen on ultrasound at the anastomotic site ( 66%), the bladder neck (16%), and posterior to the trigone (13%). In 5 % of patients there was a normal-appearing anastomotic site. Transrect al ultrasound was greater than 90% sensitive in detecting local recurr ence, but lacked specificity, Examination of the radical prostatectomy specimens in patients with local recurrence showed positive surgical margins in 66% and organ-confined disease in 20%. Conclusions. Transre ctal ultrasonography is a useful adjunct to PSA and digital rectal exa mination in the detection of local recurrences following radical prost atectomy.