Correlations between the Various Methods of Estimating Prostate Volume: Transabdominal, Transrectal, and Three-Dimensional US

OBJECTIVE: To evaluate the correlations between prostate volumes estimated by transabdominal, transrectal, and three-dimensional US and the factors affecting the differences. MATERIALS AND METHODS: The prostate volumes of 94 consecutive patients were measured by both transabdominal and transrectal US. Next, the prostate volumes of 58 other patients was measured by both transrectal and three-dimensional US. We evaluated the degree of correlation and mean difference in each comparison. We also analyzed possible factors affecting the differences, such as the experiences of examiners in transrectal US, bladder volume, and prostate volume. RESULTS: In the comparison of transabdominal and transrectal US methods, the mean difference was 8.4 +/- 10.5 mL and correlation coefficient (r) was 0.775 (p 0.05). The comparison between the transrectal and three-dimensional US methods revealed a mean difference of 3.7 +/- 3.4 mL and the correlation coefficient was 0.924 for the experienced examiner. Furthermore, no significant difference existed between examiners (p > 0.05). Prostate volume measured by transrectal US showed a positive correlation with the difference for the beginner only (r = 0.405, p < 0.05). CONCLUSION: In the prostate volume estimation by US, experience in transrectal US is important in the correlation with transabdominal US, but not with three-dimensional US. Also, less experienced examiners' assessment of the prostate volume can be affected by prostate volume itself.

The Usefullness of the Transrectal Ultrasonography in the Diagnosis of the Prostate Cancer: Comparison with Systemic Sextant Biopsy

PURPOSE: To retrospectively compared the usefulness of the transrectal ultrasonography LEAVE A SPACE(TRUS) and systemic sextant biopsy in the diagnosis of prostate cancer. MATERIALS AND METHODS: A total of 84 patients with clinical and laboratory findings suggestive of prostate cancer underwent TRUS and systemic sextant biopsy. Nine patients with diffuse prostatic lesion had been excluded from the list. Following sonographic evaluation, additional targeted biopsy for the focal lesion was performed in 14 patients. A total of 464 biopsy specimens were obtained and retrospectively compared with the sonographic findings. RESULTS: For cancer, the sensitivity, specificity and false-positive rate of TRUS were 48%, 97% and 53%, respectively. The hypoechoic nodules seen in prostate cancer were more commonly located in the outer half of the peripheral zone of the prostate, while most BPH lesions were located in the inner half of this zone. Between prostate cancer and BPH there was a statistically significant difference in the location of hypoechoic nodules revealed by TRUS (p=0.01). CONCLUSION: The location of the hypoechoic nodules provides useful information for differentiating between BPH nodoles and malignant prostatic nodules and may reduce the false-positive rate of TRUS in the diagnosis of prostate cancer.

Hypoechoic Rim of Chronically Inflamed Prostate, as Seen at TRUS: Histopathologic Findings

OBJECTIVE: The purpose of this study is to correlate the findings of peripheral hypoechoic rim, seen at transrectal ultrasonography (TRUS) in chronic prostatitis patients, with the histopthologic findings. MATERIALS AND METHODS: Seven patients with pathologically proven chronic prostatitis were involved in this study. The conspicuity of the peripheral hypoechoic prostatic rim, seen at TRUS, was prominent and subtle, and to determine its histopathologic nature, the microscopic findings were reviewed. RESULTS: In five of seven cases (71%), TRUS demonstrated a prominent peripheral hypoechoic rim. Microscopic examination revealed that inflammatory cell infiltration of prostatic glandular tissue was severe in three cases (42.9%), moderate in two (28.6%), and minimal in two (28.6%). In all seven cases, the common histopathologic findings of peripheral hypoechoic rim on TRUS were loose stromal tissues, few prostatic glands, and sparse infiltration by inflammatory cells. CONCLUSION: The peripheral hypoechoic rim accompanying prostatic inflammation and revealed by TRUS reflects a sparsity of prostate glandular tissue and is thought to be an area in which inflammatory cell infiltration is minimal.

Prostate Volume Measurement by TRUS Using Heights Obtained by Transaxial and Midsagittal Scanning : Comparison with Specimen Volume Following Radical Prostatectomy

OBJECTIVE: The purpose of this study was to determine, when measuring prostate volume by TRUS, whether height is more accurately determined by transaxial or midsagittal scanning. MATERIALS AND METHODS: Sixteen patients who between March 1995 and March 1998 underwent both preoperative TRUS and radical prostatectomy for prostate cancer were included in this study. Using prolate ellipse volume calculation (height x length x width x pi/6), TRUS prostate volume was determined, and was compared with the measured volume of the specimen. RESULTS: Prostate volume measured by TRUS, regardless of whether height was determined transaxially or midsagittally, correlated closely with real specimen volume. When height was measured in one of these planes, a paired t test revealed no significant difference between TRUS prostate volume and real specimen volume (p = .411 and p = .740, respectively), nor were there significant differences between the findings of transaxial and midsagittal scanning (p = .570). A paired sample test, however, indicated that TRUS prostate volumes determined transaxially showed a higher correlation coefficient (0.833) and a lower standard deviation (9.04) than those determined midsagittally (0.714 and 11.48, respectively). CONCLUSION: Prostate volume measured by TRUS closely correlates with real prostate volume. Furthermore, we suggest that when measuring prostate volume in this way, height is more accurately determined by transaxial than by midsagittal scanning.

Prostate Volume Measurement by TRUS Using Heights Obtained by Transaxial and Midsagittal Scanning : Comparison with Specimen Volume Following Radical Prostatectomy

OBJECTIVE: The purpose of this study was to determine, when measuring prostate volume by TRUS, whether height is more accurately determined by transaxial or midsagittal scanning. MATERIALS AND METHODS: Sixteen patients who between March 1995 and March 1998 underwent both preoperative TRUS and radical prostatectomy for prostate cancer were included in this study. Using prolate ellipse volume calculation (height x length x width x pi/6), TRUS prostate volume was determined, and was compared with the measured volume of the specimen. RESULTS: Prostate volume measured by TRUS, regardless of whether height was determined transaxially or midsagittally, correlated closely with real specimen volume. When height was measured in one of these planes, a paired t test revealed no significant difference between TRUS prostate volume and real specimen volume (p = .411 and p = .740, respectively), nor were there significant differences between the findings of transaxial and midsagittal scanning (p = .570). A paired sample test, however, indicated that TRUS prostate volumes determined transaxially showed a higher correlation coefficient (0.833) and a lower standard deviation (9.04) than those determined midsagittally (0.714 and 11.48, respectively). CONCLUSION: Prostate volume measured by TRUS closely correlates with real prostate volume. Furthermore, we suggest that when measuring prostate volume in this way, height is more accurately determined by transaxial than by midsagittal scanning.

BCG Induced Granuloma tous Prostatitis: A case report

Granulomatous prostatitis was relatively uncommon until the introduction of intravesical BCG for the treatment of bladder cancer. Since that time, there has been an increase in the number of cases of granulomatous prostatitis, but the domestic literature contains no report. We recently encountered a classic case of BCG induced granulomatous prostatitis and descrobe this case, including its radiologic findings.

Usefulness of Transrectal Ultrasound in Diagnosing Prostate Cancer: Comparison with Digital RectalExamination, Prostate-Specific Antigen and Prostate-Specific Antigen Density

PURPOSE: To determine the usefulness of transrectal ultrasonography (TRUS) in diagnosing prostate cancer bycomparing the sensitivity, specificity, accuracy, and positive and negative predictive values of TRUS with thoseof serum prostate-specific antigen (PSA), prostate-specific antigen density (PSAD) and digital rectal examination(DRE). MATERIALS AND METHODS: Two hundred and ten consecutive patients underwent TRUS-guided prostate biopsy dueto elevated PSA and/or abnormal findings on TRUS or DRE. The TRUS findings were analyzed and correlated withpathological diagnosis. PSAD was calculated by dividing the serum PSA level by the prostate volume calculated onTRUS. The sensitivity, specificity, accuracy, and positive and negative predictive values of TRUS were comparedwith those of PSA, PSAD and DRE. Using ROC curve analysis, the combinations of these diagnostic methods were alsoevaluated for the determination of efficacy in diagnosing prostate cancer. RESULTS: The sensitivity andspecificity of serum PSA (cut-off level, 4ng/ml), PSAD (cut-off level, 0.15ng/ml/cm3), DRE, and trus were 96%/17%,96%/37%, 72%/62%, and 89%/68%, respectively. On TRUS, the sensitivity and specificity of low echoic lesions andthose of irregular outer margin were 89%/69%, and 60%/90%, respectively. TRUS was statistically more accurate thanother diagnostic methods. Of the combinations of diagnostic methods, TRUS and PSAD were most accurate. CONCLUSION: TRUS demonstrated lower sensitivity but higher specificity than PSA or PSAD. Although it is an accurate modalityfor the diagnosis of prostate cancer, it cannot be used as a confirmative test due to its relatively low positivepredictive value. A combination of diagnostic methods and random biopsy is needed in patients in whom prostatecancer is suspected.

Transperineal Sonography of the Prostate in the Patients with Abdominoperineal Resection

PURPOSE: To evaluate the usefulness of transperineal sonography of the prostate in patients with previousabdominoperineal resection. MATERIALS AND METHODS: Transperineal prostatic sonograms were obtained from ninepatients with abdominoperineal resection. The shortest distance between the probe and the prostate gland, itsvolume, and its internal and external structures were evaluated for image quality, shape, border, and the degreeof distortion in internal echo. Because the number of patients was small, statistical analysis was not performed. RESULTS: Transperineal sonography of the prostate in eight patient was obtained at ease, except that one of ninepatients was not able to continue the procedure because of severe tenderness of the perineum and poor cooperation.Acceptable images of the prostate gland and their adjacent structures were obtained in one patient with less than1cm between the probe and prastate gland, three of four with between 1cm and 1.5cm, and one of three with morethan 1.5cm. CONCLUSION: In patients with previous abdominoperineal resection, transperineal sonography of theprostate may be a good imaging modality.

Small Cell Carcinoma of the Prostate: A Case Report

Primary small cell carcinoma of the prostate is a rare malignancy of unknown origin and with poor prognosis. We report a case occurring in a 74-year-old man. Radiologic findings showed that the prostate was markedly enlarged, with a lobulated contour and unclearly defined internal architecture. It was therefore impossible to distinguish it from prostatic adenocarcinoma, but the huge mass and normal range of serum tumor markers (prostate-specific antigen and prostate acid phosphatase) suggested small cell carcinoma of the prostate.