Clinical Medicine Insights: Urology

Purpose: To evaluate the feasibility of transrectal computed ultrasound tomography (TRCUT) in localization and targeted biopsy for men who have been shown to be negative in the first biopsy guided by two-dimensional transrectal ultrasound (2D TRUS) but continue to have figures suggestive of prostate cancer, so as to minimize with confidence the number of core needle biopsies, especially when the repeat or random required.

Materials and Methods: Sixty-three patients aged 53–78 years (mean, 64.9 years) with suspected prostate cancer were enrolled when a repeat or random biopsy was indicated after at least one prostatic biopsy with negative findings. The 2D TRUS random (sextant) and TRCUT guided shot-biopsies were obtained. Imaging-biopsy consequences were finally compared with the post-operative findings and the histopathologic staging.

Results: TRCUT enabled display of the prostate gland in planes usually not obtainable at conventional 2D TRUS. Transverse and oblique thin cuts of TRCUT were more significant in all patients than other planes. Diagnostic performance of TRCUT imaging on prostate cancer localization for targeted biopsy proved an accuracy of 97.4% (P value = 0.001). TRCUT for bilateral disease detection proved an accuracy of 78.6% compared to the final post-operative pathology. Accuracy for identification of positive tumor margins proved 82.4%. Gleason score on final post-operative pathology was upgraded to 7, compared with a median score of 6 on imaging biopsies.

Conclusion: TRCUT guided target-biopsy of the prostate gland represents a technique with a higher rate of accuracy and can minimize the number of biopsy shots than using 2D TRUS in men who have high PSA levels and negative in the first biopsy procedure.