An ultrasonic scanner in the field of urology is described that can be used for transurethral as well as for transrectal scanning of the bladder and prostate. The bladder was visualized best by transurethral scanning, while the rectal approach was preferable for examination of the prostate. Transurethral ultrasonography was performed in 7 patients with bladder cancer. Transrectal ultrasonography was performed in 21 controls and 41 patients with prostatic disease. The following results were obtained: 1. Diagnostic accuracy of the staging of transurethral ultrasonography was 85.7% in bladder cancer. 2. The average values of maximum anterioposterior, superio-inferior and transverse diameter. obtained from ultrasonogram were 2.43+/-0.29cm, 3.27+/-0.41cm, 4.07+/-0.91cm in control group ;3.11+/-0.6lcm, 4.16+/-0.66 cm, 4.71+/-0.76cm in B.P.H.; 3.65+/-0.46cm, 4.88+/-0.23cm, 5.98+/-0.18cm in prostatic cancer. 3. Diagnostic accuracy of transrectal ultrasonography was 93% in B.P.H. and 80% in prostatic cancer. 4. Transurethral ultrasonography enabled us to determine the degree of tumor invasion of the bladder wall and was useful to help select appropriate therapy. Transrectal ultrasonography has proved especially in estimating prostatic size and in detecting pathology.
Humans ; Pathology ; Prostate ; Prostatic Diseases ; Prostatic Neoplasms ; Ultrasonics ; Ultrasonography* ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urology

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.
Human ; Male ; Middle Age ; Prostate/*pathology/*ultrasonography ; Prostatectomy ; Prostatic Neoplasms/pathology/surgery/*ultrasonography

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.
Human ; Male ; Middle Age ; Prostate/*pathology/*ultrasonography ; Prostatectomy ; Prostatic Neoplasms/pathology/surgery/*ultrasonography

From its size, location and structure, the prostate is one of the most suitable organs for the diagnostic application of ultrasound. Transrectal ultrasonography with transrectal linear array probe was per. formed in 19 controls and 36 patients with prostatic disease to evaluate the size and morphology of prostate. The following results were obtained: 1. The average values of maximum anteroposterior, superiorinferior and transverse diameter obtained from ultrasonograms were 2.2O+/-0.30cm, 3.38+/-0.35cm, 4.18+0.35cm in control group; 3.16+/-0.78 cm, 4.79+/-0.84 cm, 5.13+/-0.62cm in BPH; 3.40+/-0.84cm, 5.25+ 1.95cm, 5.73+/-1.16cm in prostatic cancer. 2. In a comparison of sonography and x-ray for detecting prostatic calculi, the detection rate of sonography (54.5 %) was higher than x-ray (25.5%). 3. Diagnostic accuracy of sonography was 88% in BPH and 100% in prostatic cancer. 4. Ultrasonographic findings in BPH were enlarged in size, homogeneity in echo pattern and all capsular echoes are continuous. In prostatic cancers, which have mixed echo pattern and capsule is thick with discontinuity. 5. Transrectal sonography is especially useful in estimating prostatic size and in detecting pathology such as BPH, prostatic cancer, prostatitis and abscess.
Abscess ; Calculi ; Humans ; Pathology ; Prostate ; Prostatic Diseases* ; Prostatic Neoplasms ; Prostatitis ; Ultrasonography*

Nephrogenic diabetes insipidus (DI) secondary to chronic urinary tract obstruction is a rare disease. The exact cause is unknown but it is likely that increased collecting duct pressures cause damage to the tubular epithelium, resulting in insensitivity to the action of arginine-vasopressin (AVP). A 77-year-old man complaining of polyuria and polydipsia was treated with alpha glucosidase inhibitor under the impression of polyuria due to diabetes mellitus. But his symptoms did not improve. Water deprivation and AVP administration study revealed that the patient had nephrogenic DI. Urinary tract obstruction due to an enlarged prostate was suggested as a principal cause of nephrogenic DI. The patient underwent transurethral resection of the prostate and bilateral subcapsular orchiectomy. After surgery, the urine osmolarity was normalized and the patient became symptom-free. We report a case of nephrogenic DI due to obstructive uropathy which was cured by surgery eliminating obstruction.
Adenocarcinoma/ultrasonography ; Adenocarcinoma/radionuclide imaging ; Adenocarcinoma/pathology ; Adenocarcinoma/complications* ; Aged ; Case Report ; Constriction, Pathologic/etiology ; Diabetes Insipidus, Nephrogenic/etiology* ; Human ; Male ; Prostatic Neoplasms/ultrasonography ; Prostatic Neoplasms/radionuclide imaging ; Prostatic Neoplasms/pathology ; Prostatic Neoplasms/complications* ; Urologic Diseases/etiology*

The prostate-specific antigen (PSA) test contributes a lot to the diagnosis and treatment of prostate cancer (PCa) and, along with imaging-guided prostate biopsy, has improved the diagnosis rate of lower-risk PCa and the accuracy of its clinical staging. However, many questions and controversies remain as to the choice of optimal biopsy strategies. Scholars differ in views about how to utilize PCa-related biomarkers to optimize the detection of initial and repeat biopsies. This review focuses on the present status of and advances in transrectal ultrasound-guided biopsy for PCa.
Humans ; Image-Guided Biopsy ; methods ; Male ; Prostate ; pathology ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; pathology ; Ultrasonography, Interventional ; methods

OBJECTIVETo report our experience of ultrasound guided transperineal 6-core prostate biopsy (UG6CPB) in the diagnosis of prostate cancer (PCa).

METHODSIn a prospective study, we performed UG6CPB in 104 suspected PCa patients with tPSA more than 4 microg/L and analysed the positive rate and complications of the diagnostic approach.

RESULTSPCa was detected in 24 of the 104 patients (23%), with low grade Gleason 2 to 4 in 3 cases (12.5%), intermediate grade Gleason 5 to 7 in 15 (62.5%) and high grade Gleason 8 to 10 in the remaining 6 (25%). Complications included temporary hematuria in 5 patients (4.8%), mild postbiopsy perineal discomfort in 5 (4.8%) and fever in 4 (3.8%). TPSA > or =10 microg/L, fPSA > or = 2 microg/L, fPSA/tPSA < 0.16, PSAD > or = 0.2 and prostate volume < 40 ml were the significant influencing factors of biopsy positive rate (P < 0.05).

CONCLUSIONUG6CPB is an exact and a safe way of detecting PCa.

Biopsy, Needle ; methods ; Humans ; Male ; Perineum ; Prospective Studies ; Prostate-Specific Antigen ; blood ; Prostatic Hyperplasia ; diagnostic imaging ; pathology ; Prostatic Neoplasms ; diagnostic imaging ; pathology ; Ultrasonography

PURPOSE: We aimed to analyze the relationship between prostate volume and Gleason score (GS) upgrading [higher GS category in the radical prostatectomy (RP) specimen than in the prostate biopsy] in Korean men. MATERIALS AND METHODS: We retrospectively analyzed the medical records of 247 men who underwent RP between May 2006 and April 2011 at our institution. Transrectal ultrasound (TRUS) volume was categorized as 25 cm3 or less (n=61), 25 to 40 cm3 (n=121) and greater than 40 cm3 (n=65). GS was examined as a categorical variable of 6 or less, 3+4 and 4+3 or greater. The relationship between TRUS volume and upgrading of GS was analyzed using multivariate logistic regression. RESULTS: Overall, 87 patients (35.2%) were upgraded, 20 (8.1%) were downgraded, and 140 (56.7%) had identical biopsy and pathological Gleason sum groups. Smaller TRUS volume was significantly associated with increased likelihood of upgrading (p trend=0.022). Men with prostates 25 cm3 or less had more than 2.7 times the risk of disease being upgraded relative to men with TRUS volumes more than 40 cm3 (OR 2.718, 95% CI 1.403-8.126). CONCLUSION: In our study, smaller prostate volumes were at increased risk for GS upgrading after RP. This finding should be kept in mind when making treatment decisions for men with prostate cancer that appears to be of a low grade on biopsy, especially in Asian urologic fields.
Aged ; Asian Continental Ancestry Group ; Biopsy ; Humans ; Logistic Models ; Male ; Middle Aged ; Neoplasm Grading ; Prostate/pathology/ultrasonography ; Prostatectomy/*methods ; Prostatic Neoplasms/*pathology/*surgery/ultrasonography ; Retrospective Studies

AIMTo evaluate the diagnostic value of the 10 systematic transrectal ultrasound-guided (TRUS) prostate biopsy compared with the sextant biopsy technique for patients with suspected prostate cancer.

METHODSOne hundred and fifty-two patients with suspected prostate cancer were included in the study. Patients were entered in the study because they presented with high levels of prostate specific antigen (PSA) (over 4 ng/mL) and/or had undergone an abnormal digital rectal examination (DRE). In addition to sextant prostate biopsy cores, four more biopsies were obtained from the lateral peripheral zone with additional cores from each suspicious area revealed by transrectal ultrasound. Sextant, lateral peripheral zone and suspicious area biopsy cores were submitted separately to the pathological department.

RESULTSCancer detection rates were 27.6% (42/152) and 19.7% (30/152) for the 10-core and sextant core biopsy protocols, respectively. Adding the lateral peripheral zone (PZ) to the sextant prostate biopsy showed a 28.6% (12/42) increase in the cancer detection rate in patients with positive prostate cancer (P < 0.01). The cancer detection rate in patients who presented with elevated PSA was 29.3% (34/116). When serum PSA was 4-10 ng/mL TRUS-guided biopsy detected cancer in 20.6%, while the detection rate was 32.4% and 47.0% when serum PSA was 10-20 ng/mL and above 20 ng/mL, respectively.

CONCLUSIONThe 10 systematic TRUS-guided prostate biopsy improves the detection rate of prostate cancer by 28.6% when compared with the sextant biopsy technique alone, without increase in the morbidity. We therefore recommend the 10-core biopsy protocol to be the preferred method for early detection of prostate cancer.

Aged ; Aged, 80 and over ; Biopsy ; methods ; Humans ; Male ; Middle Aged ; Prospective Studies ; Prostatic Neoplasms ; diagnostic imaging ; pathology ; Ultrasonography

AIMTo investigate the pathological features of the prostate biopsy through mass screening for prostate cancer in a Chinese cohort and their association with serum prostate specific antigen (PSA).

METHODSA total of 12027 Chinese men in Changchun were screened for prostate cancer by means of the serum total prostate specific antigen tPSA test (by Elisa assay). Transrectal ultrasound-guided systematic six-sextant biopsies were performed on those whose serum tPSA value was > 4.0 ng/mL and those who had obstructive symptoms (despite their tPSA value) and were subject to subsequent pathological analysis with the aid of the statistic software SPSS 10.0 (SPSS. Inc., Chicago. USA).

RESULTSOf the 12027 cases, 158 (including 137 patients whose serum tPSA values were 4.0 ng/mL and 21 patients [serum tPSA < 4.0 ng/mL] who had obstructive symptoms) undertook prostate biopsy. Of the 158 biopsies, 41 cases of prostatic carcinoma were found (25.9 %, 41/158). The moderately differentiated carcinoma and poorly differentiated carcinoma accounted for 61% and 34%, respectively. A significant linear positive correlation between the serum tPSA and the Gleason scores in the 41 cases of prostatic carcinoma (r = 0.312, P < 0.01) was established. A significant linear positive correlation between the serum tPSA value of the 41 prostatic carcinoma and the positive counts of carcinoma in sextant biopsies was established (r = 0.406, P < 0.01), indicating a significant linear relationship between serum tPSA and the size of tumor.

CONCLUSIONThis study was the first to conduct mass screening for prostate cancer by testing for serum tPSA values and the first to investigate the pathological features of prostate cancer in a cohort of Chinese men. Our results reveal that the moderately differentiated carcinoma is the most common type of prostate cancer. This study also has shown that the serum tPSA value in prostate cancer is associated with the Gleason score and the size of tumor.

Biopsy ; methods ; China ; Humans ; Male ; Mass Screening ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; blood ; diagnosis ; diagnostic imaging ; pathology ; Ultrasonography