Fogarty K T, Arger P H, Shibutani Y, Nodine C F, Tomaszewski J E, Coleman B G, Jacobs J E, Langer J E, Wein A J
Department of Radiology, University of Pennsylvania Medical Center, Philadelphia 19104.
Radiology. 1994 Apr;191(1):69-74. doi: 10.1148/radiology.191.1.7510896.
To evaluate the role of biopsy-proved benign peripheral zone hypoechoic lesions of the prostate gland, ultrasonographic (US) characteristics at follow-up, prostate-specific antigen (PSA) levels, and digital rectal examination (DRE) in prediction of cancer risk.
Retrospective analysis was performed for 105 consecutive patients with 148 benign hypoechoic lesions discovered at transrectal US (TRUS) and diagnosed with US-guided needle biopsy. At least one repeat TRUS study was performed in each patient.
Among the benign lesions, 72% changed at follow-up TRUS, either disappearing or becoming smaller, less hypoechoic, and more vague. Cancer developed in 13% of patients. In 93% of patients in whom cancer developed, the appearance changed in the peripheral zone at follow-up TRUS. In this patient population, the positive predictive value for development of cancer was 16% with a changing TRUS appearance, 19% with an abnormal DRE result, and 27% with an elevated level of PSA; only the latter was statistically significant.
The PSA value, alone or in combination with a changing TRUS appearance, is the best indicator for development of cancer.
