Multiple criteria in sonographic diagnosis of prostatic carcinoma allows identification of all glands harboring clinically significant tumor: an in vitro study with histopathologic correlation.

Fresh whole prostate glands were examined systematically in a water bath to look for four sonographic criteria for prostatic carcinoma: well-circumscribed hypoechoic regions, external asymmetry of the gland, increase in anterior-posterior diameter ratio, and irregularity of the prostatic capsule. Whole mount sections were examined to correlate the histopathologic and sonographic findings. Using hypoechogenicity alone, 26 of 43 glands harboring tumor were identified correctly. Using all four criteria, 40 of 43 glands harboring tumor were identified, a statistically significant improvement in sensitivity (P less than 0.05). Specificity of both methods was similar (P greater than 0.1). The three tumors that were missed measured 0.5 x 0.5 x 0.5 cm, 0.5 x 0.5 x 0.5 cm, and 0.3 x 0.4 x 0.9 cm, and were found at autopsy in patients who died of causes unrelated to the prostate. The authors conclude that systematic examination of the gland with attention to multiple criteria for abnormality can improve case finding in prostatic adenocarcinoma.