Local recurrence after radical prostatectomy: Correlation of US features with prostatic fossa biopsy findings

PURPOSE: To evaluate the diagnostic accuracy of transrectal ultrasonography (US) in the detection of local recurrence following radical prostatectomy. MATERIALS AND METHODS: Ninety-nine patients with biochemical recurrence aft er radical prostatectomy were evaluated at transrectal US and prostatic fos sa biopsy. Location of suspected recurrence at transrectal US and clinical features, such as prostate-specific antigen levels and digital rectal exami nation findings, were correlated with biopsy results. RESULTS:Forty-one (41%) of 99 cases of local recurrence were detected. The percentage of sites of lesions identified at transrectal US and correspondi ng positive biopsy rates were as follows: the urethrovesical anastomotic ar ea, 56% and 61%; bladder neck, 26% and 54%; retrovesical space, 4% and 100% ; and more than one site, 14% and 71%. By comparing transrectal US and digi tal rectal examination, the sensitivities were 76% and 44% (P = .007), whil e specificities were 67% and 91% (P = .004), respectively. An increased pos itive biopsy rate with increasing prostate-specific antigen levels was note d (P = .04). CONCLUSION: Transrectal US is more sensitive but less specific than digital rectal examination in the detection of local recurrence. Biopsy findings i n more than half of the suspected lesions at the urethrovesical anastomotic area and bladder neck were positive. Lesions in the retrovesical space, al though less frequently encountered, had a high likelihood of representing c ancer recurrence.