Clinical significance of the echogenicity in prostatic ultrasound findingsin the detection of prostatic carcinoma

Background:Transrectal ultrasound is commonly performed in the clinical eva luation of the prostate. Ultrasound-guided randomized sextant biopsy became the standard procedure for the diagnosis of carcinoma of the prostate (CaP ). A guided biopsy of sonographically irregular lesions of the prostate is not performed in randomized biopsies. An almost generally accepted opinion is that hypoechoic lesions are suspicious for the presence of CaP. However, the role of prostatic lesions with an echogenicity other than iso- or hypo echoic, e.g. hyperechoic or irregular lesions in relation to CaP is not cle ar. The intention of the present prospective study was to clarify the role of different prostatic ultrasound findings with a new-generation ultrasound probe in regard to their relevance concerning the presence of cancer. Mate rial and Methods: 265 patients who were referred for prostatic evaluation b ecause of an elevated PSA serum level or a positive digital rectal examinat ion were enrolled in a prospective study. All patients had a systematic ult rasound-guided sextant biopsy of the prostate and a 4-core biopsy of the tr ansition zone. All biopsy cores taken were guided by transrectal ultrasound . In case of a sonographically suspicious lesion, biopsy was always directe d into this area. The predominant ultrasound appearance was separately reco rded for each core. Results: Carcinoma of the prostate was detected in 87 ( 32.8%) of the 265 patients, Biopsy cores with isoechoic ultrasound findings revealed CaP in 7.6%. The data for hypoechoic, hyperechoic, mixed-echoic a nd anechoic lesions were 34.5, 26,9, 21.1 and 0%, respectively. Hypoechoic ultrasound findings were less frequently found in the transition zone of th e prostate, but the rate of CaP detection was the same as in the peripheral zone of the prostate. Conclusions:The transrectal ultrasound pattern of th e prostate yields important information about the presence of carcinoma of the prostate. Especially hypoechoic lesions indicate the presence of CaP in a significant proportion of cases. However, hyperechoic lesions and lesion s of mixed or irregular echogenicity were found to contain cancer in signif icant numbers as well, and should therefore be considered to be suspicious for cancer when performing transrectal ultrasound of the prostate. Directed biopsy of irregular ultrasound patterns in the prostate seems therefore to be recommendable.