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Lee, Byun, and Lee: The Diagnostic Significance of Abnormal Findings on Transrectal Ultrasonography in Patients with Serum Prostate-Specific Antigen Levels Equal or Less than 4.0ng/ml
Original Article
Korean Journal of Urology

Korean Journal of Urology 2006; 47(7): 752-756.

Published online: 31 July 2006

DOI: https://doi.org/10.4111/kju.2006.47.7.752

The Diagnostic Significance of Abnormal Findings on Transrectal Ultrasonography in Patients with Serum Prostate-Specific Antigen Levels Equal or Less than 4.0ng/ml

Sang Wook Lee1, 2, Seok Soo Byun1, Sang Eun Lee1

Department of Urology, Seoul National University College of Medicine, Seoul, Korea.

Department of Urology, Kangwon National University College of Medicine, Chuncheon, Korea.

Corresponding author (ssbyun@snubh.org)

Received 6 March 2006       Accepted 13 April 2006

Copyright © 2006 The Korean Urological Association

Abstract

Purpose

We evaluated the diagnostic significance of abnormal findings on transrectal ultrasonography (TRUS) in men with prostate-specific antigen (PSA) levels of 4.0ng/ml or less, presented with lower urinary tract symptoms.

Materials and Methods

A total of 201 men with PSA levels of 4.0ng/ml or less underwent prostate biopsy with 12 cores. The indications for a biopsy were an elevated PSA of 3.0ng/ml or more, abnormality on digital rectal examination (DRE) and/or focal lesion on TRUS. Cancer detection rates according to TRUS and DRE findings, stratified by PSA level were investigated. Especially, the detection rates in patients who underwent prostate biopsies due to only abnormal findings on TRUS (only TRUS group) were addressed.

Results

Of the 201 patients, 45 patients (22.4%) were diagnosed as having prostate cancer. The detection rate was 4.8% (1/21), 4.8% (1/21), 38.1% (8/21), and 25.4% (35/138) in patients with PSA levels of less than 1.0ng/ml, 1.0 to 1.9ng/ml, 2.0 to 2.9ng/ml, and 3.0 to 4.0ng/ml, respectively. As for only TRUS group, the detection rate was 7.7% (2/26), 38.5% (5/13) and 21.7% (5/23) in patients with PSA levels of less than 2.0ng/ml, 2.0 to 2.9ng/ml, and 3.0 to 4.0ng/ml, respectively. For the patients with no abnormal findings on TRUS and DRE, and a PSA of 3.0 to 4.0ng/ml, the detection rate was 26.4% (24/91), and not significantly different from that of only TRUS group with a PSA of 3.0 to 4.0ng/ml.

Conclusions

It seems that prostate biopsy should be undertaken in patients with abnormal TRUS findings and PSA levels of 2.0 to 3.0ng/ml, and in all patients with PSA levels of 3.0 to 4.0ng/ml, irrespective of TRUS findings. In patients with abnormal TRUS findings and PSA levels of less than 2.0ng/ml, follow-up of PSA is recommended rather than performing immediate prostate biopsy.

Keywords: Biopsy, Diagnosis, Prostatic neoplasm, Prostate-specific antigen, Ultrasonography

Figures and Tables

Table 1
Patient characteristics
kju-47-752-i001

PSA: prostate-specific antigen

Table 2
Cancer detection rates according to PSA level
kju-47-752-i002

PSA: prostate-specific antigen

Table 3
Cancer detection rates according to TRUS and DRE findings, stratified by PSA level
kju-47-752-i003

PSA: prostate-specific antigen, TRUS: transrectal ultrasonography, DRE: digital rectal examination. Only TRUS, only DRE, TRUS+ DRE, and TRUS(-)DRE(-) denote the indications for a prostate biopsy in each group.

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