No abstract available.
Diagnosis* ; Prostate* ; Prostatic Neoplasms* ; Ultrasonography*

PURPOSE: We assessed the influence of age and prostate volume on the serum total PSA and percent free PSA level, and total PSA on the percent free PSA level in men with benign prostatic disease except clinically detectable prostatic cancer. MATERIALS AND METHODS: Sera were obtained from 250 men with total PSA level of 0 to 20 ng/ml who were clinically negative for cancer. Total and free PSA levels were measured using ELSA-PSA2 and FPSA-RIACT immunoradiometry assay. Prostate volume was determined by transrectal ultrasound. RESULTS: Age and prostate volume correlated significantly with Total PSA levels (r=0.204 and 0.482, p<0.05) and free PSA levels (r=0.246 and 0.539, p<0.05) but not with percent free PSA(r=0.057 and -0.039, p=0.188 and 0.541). Total PSA levels correlated significantly with free PSA(r=0.853, p<0.05) and percent free PSA(r=-0.398, p<0.05). CONCLUSIONS: Among men with total PSA levels of 0 to 20 ng/ml and do not have clinically detectable prostatic cancer, total PSA and free PSA increases with increasing age and prostate volume. And percent free PSA decreases with increasing total PSA but it was not influenced by age and prostate volume.
Humans ; Male ; Prostate* ; Prostatic Diseases* ; Prostatic Neoplasms ; Ultrasonography

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

Elevations of serum PSA concentrations have been widely reported due to prostatic cancer, but other causes haute not been formally characterized or quantified. So that, we evaluated the causes of elevated serum PSA concentrations in men whose prostate biopsy showed no cancer. The effects of prostate volume, inflammation, echogenecity on ultrasound and calculi were examined in 43 men that serum PSA concentrations greater than 4.0 ng/ml with negative biopsy. These men were compared with 16 men who had suspicious rectal examinations, negative biopsy and serum PSA concentrations of 4.0 ng/ml. or less. Prostate volume (22.5%, p<0.005) and inflammation (3%, p<.05) were significantly associated with elevated serum PSA concentrations (>4.0 ng/ml) than control group (< or = 4.0 ng/ml) and age echogenecity on ultrasound and calculi were statistically less significant (p> or =0.05). In summary, prostate volume and inflammation were the most important factors contributing to increase serum PSA concentration in men that clinically undetectable prostatic cancer.
Biopsy ; Calculi ; Humans ; Inflammation ; Male ; Prostate ; Prostatic Neoplasms ; Ultrasonography

Purpose: We evaluated the improvement in the rate of prostate cancer detection with the use of an extensive 12-site biopsy protocol in patients with only an elevated level of serum prostate-specific antigen (PSA). Materials and Methods: A total of 109 men with elevated PSA levels between 3 and 20ng/ml, but with no abnormal finding on digital rectal and transrectal ultrasound examinations, received transrectal ultrasound- guided prostate biopsies, which were performed at 12 sites, including the routine sextant and 6 far lateral regions (lateral apex, mid-lobe and base). The improvement in the detection rate was assessed according to the PSA level and prostate volume. Results: The mean age and PSA level of the patients were 63.5 8.6 years and 7.0 3.7ng/ml, respectively. Twenty-eight (25.7%) out of 109 men were diagnosed with prostate cancer. A traditional sextant biopsy detected 19 (67.9%) of the 28 prostate cancer patients, while 9 (32.1%) cancers were detected in the lateral region only. Overall, this extensive protocol resulted in a significant improvement, 8.3% (17.4 to 25.7%), in the detection rate (p=0.032). The improvement in men with a PSA of 10 ng/ml or less was 8.1% (14.0% to 22.1%, p=0.007) and in those with a PSA greater than 10 ng/ml the improvement was 8.7% (30.4% to 39.1%, p=0.162). The improvement in men with a prostate volume of 50cc or less was 8.0% (22.3% to 30.3%, p=0.083) and in those with a prostate volume greater than 50cc this was 9.1% (6.1% to 15.2%, p=0.043). Conclusions: The twelve-site biopsy protocol is a more efficient method in men with a PSA and prostate volume of 10ng/ml or less and greater than 50cc, respectively, compared to the sextant protocol.
Biopsy* ; Humans ; Male ; Prostate ; Prostate-Specific Antigen* ; Prostatic Neoplasms ; 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*

There have been much limitations and errors in evaluating prostatic conditions by traditional radiologic methods due to its location and anatomical structure. However recent introduction and improvement of the ultrasonography have been enabled us to visualize boundary of the prostate clearly and differentiate the variable findings within the prostate. Transrectal or transurethral ultrasonography of the prostate is popular nowadays, however we performed suprapubic ultrasonography of which merits are traumatic to the patients, easy to perform and it requires no adjustments or additions to basic ultrasound equipment. In order to evaluate ultrasonogram of the prostate in patients with prostatic diseases and normal adults and compare preoperative volume of the prostate on ultrasonographic estimation with postoperative volume, 31 patients with prostatic diseases and 40 normal adults under the age 60 were studied with suprapubic ultrasonography. The results obtained were as follows. 1. On ultrasonographic picture of the prostate, normal adults showed symmetrical or triangular or elliptical appearance and there were numerous fine homogenous spots within the prostate. BPH patients showed symmetric, round or oval shapes and its margin was smooth and numerous fine spots were seen within the prostate as normal adults. The prostatic size enlarged and elevated to the bladder base. Advanced prostatic cancer patients showed dyssymmetric irregular appearance. The prostate of acute prostatitis patients resembled normal prostate but prostatic size enlarged. 2. The mean prostatic volume of normal adults on ultrasonographic estimation was 21.30+/-24.80 cm3 and there were no differences of the prostatic volume between ages. 3. The mean prostatic volume of 21 BPH patients on ultrasonographic estimation was 46.2+/-17.2 cm3 and majority patients were in 33.49-61.56 cm3. 4. Comparisonal studies between preoperative ultrasonographic prostatic volume and resected prostatic volume showed correlation coefficient 0.98 (P<0.005) and mean error rate 17.58+/-8.1%. Most cases showed preoperative prostatic volume was larger than the postoperative volume which was probably due to inadequate removal of tissue and surgical capsule. As results of the above, the suprapubic ultrasonography was helpful in differential diagnosis of the prostatic diseases and estimation of the prostatic size.
Adult ; Diagnosis, Differential ; Humans ; Prostate ; Prostatic Diseases* ; Prostatic Neoplasms ; Prostatitis ; Ultrasonography ; Urinary Bladder

We evaluated the role of prostate specific antigen(PSA), digital rectal examination(DRE) and transrectal ultrasound(TRUS) in the diagnosis of prostate cancer. Of 93 patients with pathologically proven diagnosis, 19 patients had prostate cancer and 68 patients had BPH, while remaining 6 patients had other benign prostatic disease. Among the patients with prostate cancer, 17 patients had elevated PSA level(89%) and most of their PSA levels elevated above 10ng/ml(79%), while 2 patients with stage A disease had normal PSA level. Of 26 patients whose PSA levels were between 4 and 10microgram/ml, only 2 patients had prostate cancer(7.7%). However, these patients had significantly elevated PSA density compared to others. The positive predictive value of PSA, DRE and TRUS was 27%, 44% and 40% respectively. DRE and TRUS had 56% and 58% positive predictive value in patients with elevated PSA level in contrast to 0% positive predictive value of DRE and TRUS in patients with normal PSA level. When all three methods were combined, the positive predictive value rose to 67%. Although positive predictive value of DRE and TRUS was 44 and 40 % respectively, these methods appeared to be valuable when PSA level elevated concomitantly. Our data suggest that prostate biopsy should be performed in patients with elevated PSA level above 10ng/ml and PSA density might be valuable in patients with marginal PSA level (4-10ng/ml).
Biopsy ; Diagnosis* ; Digital Rectal Examination* ; Humans ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Diseases ; Prostatic Neoplasms* ; Ultrasonography*

PURPOSE: The aim of this study is to correlate the findings at prostate CDS (Color doppler sonography) with those of site specific transrectal ultrasound (TRUS) guided biopsy for determining the role of CDS in detection of prostate cancer. MATERIALS AND METHODS: Forty-nine patients underwent TRUS guided biopsy because of palpable hard nodule of prostate, abnormal prostate specific antigen, or hypoechoic lesion of TRUS. CDS was performed at all biopsy sites before TRUS guided biopsy. Color flow at CDS was prospectively graded on a scale of 0, I, II (0=no or minimal, I=moderate, II=markedly increased color flow at peripheral zone). CDS results were correlated with histologic findings from 491 separate biopsy sites of 49 patients. RESULTS: Cancer was found on biopsy in 153 sites, prostatitis was found in 95 sites, and benign prostatic hyperplasia (BPH) was found in 243 sites. CDS had a sensitivity of 30.1%, specificity of 98.2%, positive predictive value of 88.5%, and negative predictive value of 75.6%. Of 52 grade II color flow biopsy sites, 46 were prostate cancer, prostatitis and BPH were 3 each other. Of 153 biopsy sites in prostate cancer, 46 sites were grade II, 62 sites were grade I, 45 sites were grade 0 color flow. CDS depicted cancer in 43 sites of 5 patients without gray scale abnormality. Of 16 patients with hypoechoic lesion, eight patients had cancer, but CDS did not assist to differentiate the cancer from benign lesion. CONCLUSIONS: Grade II color flow in peripheral zone is highly associated with prostate cancer. In case of no gray scale abnormality, CDS may help identify appropriate sites for biopsy. But, negative CDS do not exclude biopsy because of low sensitivity.
Biopsy* ; Humans ; Prostate* ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Prostatitis ; Sensitivity and Specificity ; Ultrasonography*

PURPOSE: To determine the demographic and tumor related predictors of repeat biopsy cancer detection in men diagnosed with benign prostatic tissue following an initial prostate biopsy. We evaluated the clinical parameters of prostate cancers detected on repeat biopsy. MATERIALS AND METHODS: Between May 1994 and 2001, 1,016 patients with suspected prostatic cancer underwent a transrectal ultrasound guided prostate biopsy. Of the 721 patients whose biopsy specimens were negative for prostate cancer, 53 had a repeat prostate biopsy for persistently, or abruptly elevated, prostate specific antigen (PSA) values. We examined their serum PSA, PSA density, free to total PSA value, annualized interbiopsy PSA change and biopsy core numbers, as well as their age, prostate size and the histological results of their initial, and repeated, biopsies, to determine if any predictor of the need for a repeat biopsy could be identified. RESULTS: From the repeat biopsies, 15 patients (28.3%) had prostate cancer. There were significant differences between the benign and malignant repeat biopsies, in relation to PSA density (p=0.001), free to total PSA value (p=0.002) and annualized interbiopsy PSA change (p=0.001). No patient with high-grade prostatic intraepithelial neoplasia was subsequently found to have cancer. CONCLUSIONS: The PSA density, free to total PSA value and annualized interbiopsy PSA change appear to aid in the prediction of cancer on a repeat biopsy.
Biopsy* ; Humans ; Male ; Prostate* ; Prostate-Specific Antigen ; Prostatic Intraepithelial Neoplasia ; Prostatic Neoplasms* ; Ultrasonography