Outcomes of transrectal ultrasound scan of the prostate with sector biopsies for 323 New Zealand men with suspicion of prostate cancer

Aims. To assess the results and clinical outcomes of the first four years o f transrectal ultrasound scanning (TRUS) with sector biopsies of the prosta te, as the definitive second-line investigation for men with suspicion of p rostate cancer, including comparability with subsequent information from hi stology of surgical specimens. Methods. Information was collated from the author's ongoing surgical audit. TRUS and sector biopsies were carried out as a rooms procedure using a Tos hiba Sono-Layer SSA-270A ultrasound machine with a PVL 725 RT transrectal p robe and biopsy guide. Six or eight sector biopsies were taken with a Manan biopsy gun using 18 French gauge biopsy needles. Prophylactic ciprofloxaci n and tinidazole were administered. Men with suspicion of prostate-specific antigen assay or digital rectal examination were considered for the invest igation, especially if they were candidates for potentially curative treatm ents. Results. Of 330 TRUS procedures performed on 323 men, 328 were done in room s under local anaesthetic. The only significant complication was a transien t bacteraemia in one patient not taking the antibiotics. Twenty men had pro state intraepithelial neoplasia or atypia, and 94 (29%) had cancer, of whom 24 (25%) had evidence of metastases. Curative treatment by radical prostat ectomy or radiotherapy was attempted in 62 men (66%) and 28 are being manag ed by surveillance only. Comparisons with subsequent radical prostatectomy in 44 men showed that if only one TRUS biopsy core was involved with cancer (15 men), surgical margi ns were clear. For those with more cores involved (29 men), one-third (9 me n) had positive margins or capsular perforation. The Gleason Score was diff erent, more often higher, for 29 men by histology at radical prostatectomy compared to TRUS. Twenty-eight men had a subsequent transurethral resection of the prostate of which the histology resulted in management changes for ten of the 28, including three who were placed on surveillance and seven wh o underwent radical prostatectomy. Conclusions. TRUS and sector biopsy is a tolerable rooms procedure for men with suspician of prostate cancer. Complications are rare if prophylactic a ntibiotics are taken. The procedure provides information of sufficient qual ity to advise patients further. Na defects in specificity were detected. De fects in sensitivity were demonstrated by comparison with later histology f ollowing transurethral resection. Therefore, men with benign results at TRU S need ongoing follow-up. TRUS histology tends to underestimate the extent of cancer present as determined by subsequent radical prostatectomy histolo gy. When used with prostate-specific antigen and digital rectal examination , TRUS and sector biopsy is capable of detecting prostate cancer before it has metastasized, more reliably than if symptoms are awaited before diagnos is is attempted. It may also recognize forms of cancer of apparent low clin ical significance which can be managed by surveillance.