PROSTATE IMAGING MAY NOT BE NECESSARY IN NONPALPABLE CARCINOMA OF THEPROSTATE

Objectives. Stage T1 c carcinoma of the prostate is defined as a nonpa lpable carcinoma (NPC-P) that is not visible by imaging and is identif ied by needle biopsy performed because of elevated prostate-specific a ntigen (PSA) concentrations. The purpose of this study was to define t he incidence of normal findings on transrectal ultrasound (TRUS) and/o r endorectal coil magnetic resonance imaging (EMRI) among patients wit h NPC-P, as well as to investigate the value of differentiating patien ts with Stage Tie disease from all other patients with NPC-P. Methods. The records of 2211 patients diagnosed with prostate carcinoma betwee n 1988 and 1995 were reviewed to identify 291 men with NPC-P. TRUS and EMRI reports were analyzed with regard to the presence and laterality of hypoechoic nodules or low-signal areas reported on T2-weighted ima ges, respectively, Ninety percent of patients (n = 262) had at least s ix prostate biopsies, 185 patients (64%) underwent both TRUS and EMRI, 224 (77%) had TRUS, and 251 (86%) had an EMRI study. Results. Results were considered normal in 101 (47%) of 214 patients undergoing TRUS, in 58 (23%) of 249 undergoing EMRI, and in 22 (12%) of 185 undergoing both TRUS and EMRI. For the side of the prostate with positive biopsy results, correlation with imaging abnormalities was better for EMRI th an for TRUS (39% versus 24%). There was no significant difference in m ean PSA value, distribution of Gleason score, or unilateral versus bil ateral positive biopsy results among patients with normal versus abnor mal findings on both TRUS and EMRI. Conclusions. (1) Only 12% of men w ith NFC-P have no TRUS or EMRI abnormalities, fulfilling the criteria for Stage Tie prostate carcinoma. (2) Those patients with Stage Tie di sease do not differ from patients with NPC-P up-staged by TRUS or EMRI , with regard to pretreatment PSA levels, Gleason scores, and the prob ability of having bilateral rather than unilateral positive biopsy res ults. (3) The value of classifying patients with NPC-P into Stage Tie versus higher stages of prostate carcinoma on the basis of imaging sho uld be questioned. (C) 1997, Elsevier Science Inc. All rights reserved .