FOLLOW-UP OF BENIGN HYPOECHOIC PERIPHERAL ZONE LESIONS OF THE PROSTATE-GLAND - US CHARACTERISTICS AND CANCER PREVALENCE

PURPOSE: To evaluate the role of biopsy-proved benign peripheral zone hypoechoic lesions of the prostate gland, ultrasonographic (US) charac teristics at follow-up, prostate-specific antigen (PSA) levels, and di gital rectal examination (DRE) in prediction of cancer risk. MATERIALS AND METHODS: Retrospective analysis was performed for 105 consecutive patients with 148 benign hypoechoic lesions discovered at transrectal US (TRUS) and diagnosed with US-guided needle biopsy. At least one re peat TRUS study was performed in each patient. RESULTS: Among the beni gn lesions, 72% changed at follow-up TRUS, either disappearing or beco ming smaller, less hypoechoic, and more vague. Cancer developed in 13% of patients. In 93% of patients in whom cancer developed, the appeara nce changed in the peripheral zone at follow-up TRUS. In this patient population, the positive predictive value for development of cancer wa s 16% with a changing TRUS appearance, 19% with an abnormal DRE result , and 27% with an elevated level of PSA; only the latter was statistic ally significant. CONCLUSION: The PSA value, alone or in combination w ith a changing TRUS appearance, is the best indicator for development of cancer.