The Role of Transrectal Ultrasound for Finding Focal Lesions in Prostate Cancer Detection Compared to Systematic Sextant Biopsy

Publication date: Available online 10 October 2018

Source: Academic Radiology

Author(s): Moon Hyung Choi, Young Joon Lee, Seung Eun Jung

Objectives

To evaluate the difference in cancer detection rate between targeted biopsy of focal lesions detected on transrectal ultrasound (TRUS) and systematic sextant biopsy.

Materials and Methods

This retrospective study included patients who underwent TRUS-guided prostate biopsy between April 2014 and April 2017 and classified them into three groups: (1) sextant biopsy group patients underwent systematic sextant biopsy without evaluation of focal lesions on TRUS (n = 400), (2) focal lesion group patients underwent targeted biopsy for TRUS-detected lesions (n = 496), and (3) nonfocal lesion group patients had no TRUS-detected focal lesions (n = 222). Positive biopsy rates were compared using Chi-square tests between biopsy groups in all patients and two subgroups divided by prostate-specific antigen (PSA) level of 10ng/mL.

Results

The positive biopsy rate decreased in the order of the focal lesion group, the sextant biopsy group, and the nonfocal lesion group. All prostate cancers and prostate cancers with a Gleason score ≥7 were detected more frequently among patients with PSA ≤10ng/mL in the focal lesion group than in the sextant biopsy group ( p = 0.008 and 0.007, respectively) and less frequently among patients with PSA >10ng/mL in the nonfocal lesion group than in the sextant biopsy group ( p = 0.007 and 0.003, respectively).

Conclusion

In conclusion, searching focal lesion by TRUS is useful for improving the positive biopsy rate and risk stratification of PCa compared to systematic sextant biopsy without careful TRUS examination.

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