The incidence of hyperechoic prostate cancer in transrectal ultrasound-guided biopsy specimens.

OBJECTIVES

To estimate the incidence of transrectal ultrasound (TRUS) hyperechoic lesions and of hyperechoic prostate cancer in TRUS-guided biopsy specimens.

METHODS

We prospectively studied 200 patients with total prostate-specific antigen values less than 20 ng/mL and/or positive results on digital rectal examination who had undergone TRUS-guided prostate biopsy. Each patient underwent laterally directed systemic six-core biopsy plus cores from abnormal TRUS lesions and rectally palpable lesions. Six to 10 biopsy cores were obtained from each patient.

RESULTS

Hyperechoic lesions were found in 19 patients (9.5%), hypoechoic in 83 (41.5%), and isoechoic in 98 (49.0%). Prostate cancer was diagnosed in 33.0% of study patients. Isoechoic findings on TRUS were recorded in 31.8% of patients diagnosed with prostate cancer, whereas 60.6% of cancers had hypoechoic and 7.6% hyperechoic lesions. There was no significant difference in the mean Gleason score between isoechoic cancers (mean 5.4) and hypoechoic cancers (mean 5.6). However, hyperechoic cancers had a mean Gleason score of 7.0, which was higher when compared with isoechoic and hypoechoic cancers.

CONCLUSIONS

Biopsy of hyperechoic lesions was positive for prostate cancer in a higher percentage of patients than previously reported in the literature, and Gleason score of these cancers was higher when compared with isoechoic and hypoechoic cancers.