[Potential of ultrasonography and ultrasonography-guided biopsy in the diagnosis of local recurrence following radical prostatectomy].
INTRODUCTION: [corrected] We investigated the diagnostic role of combined transrectal US (TRUS) and biopsy to detect recurrent cancer after radical prostatectomy, in patients with negative bone scintigraphy and elevated prostate specific antigen (PSA) levels. MATERIALS AND METHODS: From March, 1997, to May, 1998, we examined 12 patients with persistently detectable serum PSA levels and negative bone scintigraphy. At the time of diagnosis, an average 36 months had elapsed since prostatectomy. Digital rectal examination (DRE) and disease stage at the time of surgery were also considered. Patients age ranged 47 to 83 years (mean: 65). All patients underwent TRUS with a 7.5 MHz biplane probe; biopsy was performed with a 16 G cutting needle. TRUS findings were considered suspicious if the scan showed any unusual hypoechoic tissue adjacent to the bladder neck, in retrotrigone or peri-retroanastomotic site. In these cases a transperineal US-guided biopsy was performed. RESULTS: The biopsy proved cancer in 10/12 cases (in 12 cases after two biopsies), showing a better diagnostic accuracy than DRE, which poorly distinguished postoperative changes from recurrent or residual cancer. CONCLUSIONS: The early detection of recurrences after radical prostatectomy in patients with negative bone scintigraphy is feasible when the above examinations are performed in the same order as described: PSA levels, if altered, indicate the patients to be submitted to TRUS. The latter may be falsely negative in some cases because small recurrences may exhibit no findings at US, and therefore US-guided biopsy of peri-retro-anastomotic regions should be always performed too. The recurrence must be confirmed at histology because histologic findings help choose adjuvant treatment and/or radical irradiation.