Two hundred fifty-six patients with hypoechoic lesions of the prostate found at transrectal ultrasound (US) were evaluated with prostate-specific antigen (PSA) study, digital rectal examination (DRE), and US-guided transrectal biopsy. Positive predictive values for cancer were calculated for transrectal US alone and in combination with DRE, PSA study, or both. Results were correlated with lesion size. The positive predictive value for transrectal US alone was 41%; this value increased to 61% if the patient had positive results from DRE, 52% if the PSA level was elevated, and 71% if both the DRE results and PSA level were abnormal. The positive predictive value for transrectal US fell to 24% if results of the DRE were normal, 12% if the PSA level was normal, and 5% if both DRE results and PSA level were normal. No cancers were detected in lesions 1.0 cm or smaller if DRE results and PSA level were normal. DRE and PSA study are valuable complements to abnormal transrectal US examinations. Biopsy of small suspicious lesions may not be indicated if results of both of the studies are normal.

Adenocarcinoma of the prostate produces specific ultrasonic findings that can be used in diagnosis. We have examined 211 patients using transrectal ultrasound in both the sagittal and axial planes. Thirty-three carcinomas were detected, and 31 histologically confirmed; 24 by needle biopsy, six by transurethral resection, one by total prostatectomy, and two by the demonstration of distant metastases. On ultrasound, all of the carcinomas were less echogenic than normal prostate. All appeared to originate in the peripheral zone of the prostate and produced asymmetry of the gland. The majority of carcinomas in this series showed capsular involvement and ten penetrated and extended beyond the prostatic capsule. The results of this series indicate that transrectal ultrasound can be used to detect cancer of the prostate gland. Ultrasound demonstrated the extent of tumor involvement and enabled accurate staging of these cancers.

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Over a 7-month period, from a total of 417 transrectal ultrasound (US) studies, 45 transperineal biopsies of the prostate were performed in the radiology department. Transrectal US guidance and local anesthesia were used. Twenty-two of 32 hypoechoic lesions, located within the peripheral zone tissue of the gland, were proved by histologic study to be cancerous. Hyperechoic lesions were all histologically benign hyperplasias. The patients experienced no major complications necessitating hospitalization or increased length of hospital stay as a result of the procedure.