[Clinical and ultrasonographic characteristics of prostatic cancer diagnosed with transrectal biopsy]

To analyze the clinical, ultrasound and pathological characteristics of patients with prostate cancer diagnosed by ultrasound-guided transrectal biopsy who consulted for lower urinary tract symptoms compatible with benign hyperplasia of the prostate.

From 1994 to 1998 ultrasound-guided transrectal biopsy of the prostate was performed in 1,548 patients aged 49-90 years (mean age 70 +/- 7). Of these, 613 (40%) were diagnosed with cancer. Biopsy was performed in 161 patients (60%) with elevated PSA but no suspicion of cancer on digital rectal examination, and 452 patients with a suspicious DRE. Only 10 of these 452 patients (2%) had a PSA value within the normal ranges. Ninety-seven percent of the patients with cancer were diagnosed at the first biopsy.

The DRE findings were compatible with locally advanced cancer in 25% of the patients. An echogenic nodule was detected in 79%; the nodule was hypoechoic in 93% of the cases. Ninety-four percent of the patients with a suspicious DRE versus 37% of those with a normal DRE showed a nodule on ultrasound (p < 0.001). According to the ultrasound and DRE findings, 41% of the patients had a localized cancer. Cancer was diagnosed in 70% of the patients with a nodule; 51% of the cases had high grade carcinoma (score 8, 9 or 10). Sixty percent of the patients with a suspicious DRE had high grade cancer versus 30% of the patients with a normal DRE (p < 0.001). Twenty-three percent of the patients underwent radical prostatectomy. Only 34% of the patients had a localized tumor.

Most of the tumors of the prostate diagnosed in patients who presented with lower urinary tract symptoms compatible with BHP were high grade and locally advanced and therefore not susceptible to cure. PSA determination and digital rectal examination at the primary care level can be useful in detecting prostate cancer in the early stages without significantly increasing costs.