Clinicopathological Features of Prostate Cancer Detected by Transrectal Ultrasonography‐Guided Systematic Six‐Sextant Biopsy

Background: The objectives of this study were to compare the efficacy of 3 modalities (prostate-specific antigen (PSA) assay, digital rectal examination (DRE), and transrectal tiltrasonography (TRUS)) in detecting prostate cancer which was pathologically confirmed by TRUS-guided systematic six-sextant biopsy, and to investigate the relationship between the number of positive cores and several clinicopathological parameters. Methods: Between 1992 and 1994, 297 males (1 55 from a mass screening program and 142 identified as outpatients) with a mean age of 71 years, underwentexaminations including PSAdetermination, DRE, TRUS and systematic six-sextant biopsy, and/or additional directed biopsy. Results: Prostate cancer was detected in 93 men. The sensitivity level of the PSA assay was significantly higher (85%) than that of either DRE or TRUS. Patients with an abnormal DRE or TRUS, elevated PSA levels, and those in the T3-T4 category or with moderate to poorly-differentiated adenocarcinomas had more positive biopsy cores (P 10 ng/mL, but low (9%) in subjects with a PSAI 4 ng/mL, and the percentage of negative biopsy cores with a normal TRUS was high (98%) in subjects with a PSA of 5 4 ng/mL, but lower (67%) in subjects with a PSA > 10 ng/mL. Conclusion: Theserum PSA assay was more useful than either DREor TRUS in detecting prostate cancer. The percentage of bone metastasis increased concomitant with the number of positive biopsy cores, and the positive biopsy rate of hypoechoic areas positively correlated with the PSA level. Int J Urol 1997;4:474-479