OBJECTIVE: To improve the diagnostic efficacy of transrectal ultrasound (TRUS)-guided targeted prostatic biopsies, we have suggested the use of a new scoring system for the prediction of malignancies regarding the characteristics of focal suspicious lesions as depicted on TRUS. MATERIALS AND METHODS: A total of 350 consecutive patients with or without prostate cancer who underwent targeted biopsies for 358 lesions were included in the study. The data obtained from participants were randomized into two groups; the training set (n = 240) and the test set (n = 118). The characteristics of focal suspicious lesions were evaluated for the training set and the correlation between TRUS findings and the presence of a malignancy was analyzed. Multiple logistic regression analysis was used to identify variables capable of predicting prostatic cancer. A scoring system that used a 5-point scale for better malignancy prediction was determined from the training set. Positive predictive values for malignancy prediction and the diagnostic accuracy of the scored components with the use of receiver operating characteristic curve analysis were evaluated by test set analyses. RESULTS: Subsequent multiple logistic regression analysis determined that shape, margin irregularity, and vascularity were factors significantly and independently associated with the presence of a malignancy. Based on the use of the scoring system for malignancy prediction derived from the significant TRUS findings and the interactions of characteristics, a positive predictive value of 80% was achieved for a score of 4 when applied to the test set. The area under the receiver operating characteristic curve (AUC) for the overall lesion score was 0.81. CONCLUSION: We have demonstrated that a scoring system for malignancy prediction developed for the characteristics of focal suspicious lesions as depicted on TRUS can help predict the outcome of TRUS-guided biopsies.
Aged ; Aged, 80 and over ; Area Under Curve ; Biopsy/methods ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prostate/ultrasonography ; Prostatic Neoplasms/classification/*diagnosis/*ultrasonography ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasound, High-Intensity Focused, Transrectal/*methods

To develop criteria for prostatic cancer patient care related to early diagnosis, treatment according to accurate staging and follow up in Korea, a clinical study was made on 49 patients with prostatic malignancy who were admitted to the Departrnent of Urology, Korea University College of Medicine between January 1981 and December 1985. The results were as follows 1. The incidence of prostatic malignancy was 1.6% of all inpatients, 2.2% of male inpatients and 10.1% of all male G-U tract tumors. 2. The age distribution ranged from 17 to 85 years with the highest incidence of 60 to 80 years (65%) and 3 of these 49 patients (6.1%) were men less than 40 years old. 3. The incidence of prostatic cancer has increased over the years with B.P.H. and the numbers of patients was comparable to the numbers of patients with B.P.H. during this period representing 49 and 214. 4. Prostatism (59%) and acute urinary retention (41%) were two common presenting symptoms, with symptom caused by metastasis such as persistent bone pain (14%) and pulmonary symptoms (4%). 5. On digital rectal examination at admission, 12 patients had a hard nodule in the prostate with 8 patients of multiple nodules, and 7 patients had soft, smooth prostate presumed B.P.H. 6. Of 9 tumors that extended over the prostate by Intraoperative palpation, 7 (78%) were identified by transrectal ultrasonography but only 2(22%) were identified correctly by digital rectal examination. Transrectal ultrasonography was especially useful in detecting and staging the prostatic cancer. 7. Perineal or transrectal prostatic needle biopsy was done in 29 patients. Adenocarcinoma was found in 26 patients and rhabdomyosarcoma in 3 patients. The histopathologic classification of 3 rhabdomyosarcomas was embryonal, alveolar and pleomorphic. 8. Distant metastasis was found in 28 patients (57%): The sites involved were bone in 24 patients, lymph node in 5 patients, lung in 3 patients and liver and skin in each 1 patient. The sites most frequently involved were pelvis (65%) and spine (50%) in the bony skeleton, and obturator lymph nodes (60%) in lymph node metastasis. 9. In 54% of the patients in which bone scans were positive for metastasis conventional radiographic surveys were negative. The nuclear bone scan was a highly sensitive means for detecting skeletal metastasis 50% more than the conventional bone radiography. 10. The patients were grouped according to American Urological system. 30(6l.2%) patients had stage D, 7(l4.3%) had stage C, 6(12.2%) had stage B and 6 had stage A. Of 6 patients with stage A 4 had histologically proved stage A1, 2 had stage A2. Grade III lesions made up to the largest group accounting for approximately half (47%) of the total patients. This study showed significant correlation between tumor grades and clinical stage of the disease, demonstrating a shift from lower to higher clinical stage with increasing tumor grades. 11. Patients with clinical stage B lesions were preferentially and best treated with prostatectomy, stage C with external beam radiation therapy, stage D with endocrine therapy. 3 patients with prostatic rhabdomyosarcoma were treated with radiation and systemic chemotherapy and one of these 3 patients was also treated with total cystoprostatectomy and urinary diversion. 12. Follow up study with serial measurements of acid phosphatase level and assessment of clinical status was made on 24 patients. (2l patients of adenocarcinoma, 3 patients of rhabdomyosarcoma, Of the 4 patients who had a response as determined by acid phosphates level 3 patients (75%) improved in clinical status and mean survival was more than 24 months. Of the 3 patients who had no change in acid phosphatase level 2 patients (67 %) deteriorated in clinical status and had a mean survival of 7 months. Of the 9 patients who had a progression in acid phosphatase level 7 patients (78 %) deteriorated in clinical status and had a mean survival of 10 months.
Acid Phosphatase ; Adenocarcinoma ; Adult ; Age Distribution ; Biopsy ; Biopsy, Needle ; Classification ; Digital Rectal Examination ; Drug Therapy ; Early Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Inpatients ; Korea ; Liver ; Lung ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Palpation ; Patient Care ; Pelvis ; Phosphates ; Prostate ; Prostatectomy ; Prostatic Neoplasms ; Prostatism ; Radiography ; Rhabdomyosarcoma ; Skeleton ; Skin ; Spine ; Ultrasonography ; Urinary Diversion ; Urinary Retention ; Urology