Early detection of local disease progression from stage A1 prostate carcinoma by transrectal ultrasonography

Fifty-two patients with Stage A1 prostate cancer diagnosed by transurethral resection performed between 1975 and 1989 were re-examined by transrectal ultrasonography and ultrasonographically guided biopsies. Follow-up after the initial diagnosis ranged from 1 to 15 years (mean, 5.8 years). For eight patients, results of digital rectal examination were abnormal. For 44 patients, results were normal or indicated a low probability of cancer. Serum prostate-specific antigen (PSA) levels (4.6 to 14.6 ng/ml) were elevated in ten patients. Ultrasonography showed from one to three hypoechoic areas in 29 patients. Locally progressive disease, defined as moderately to poorly differentiated cancer, was detected in five (10%) patients, three of whom underwent radical prostatectomy. Histopathologic examination of the specimens revealed localized disease (no capsular invasion). The remaining two patients had radiation therapy. In three patients, results of digital rectal examination and the serum PSA level were normal, but focal, well-differentiated cancer, identical to that initially diagnosed, was detected after a follow-up of 5 to 10 years. Because the clinical significance of this finding is unknown, these three patients were not considered to have progressive disease and did not have additional treatment. Our data suggest that transrectal ultrasonography is valuable in early detection of local disease progression and should be used in the follow-up program for patients with Stage A1 prostate cancer.