Evaluation of prostatic carcinoma: noninvasive and preoperative techniques

Transrectal ultrasonography was performed in 345 patients with clinical benign prostatic hyperplasia who underwent simple prostatectomy. Four patients with negative ultrasonic scans were found to have stage A2 prostatic tumors. Of the 57 patients with positive scans, ten were found to have clinically unsuspected carcinoma; however, changes secondary to carcinoma could not reliably be differentiated from those resulting from chronic inflammation and calculi. Transrectal portable ultrasonography is useful for the staging of patients with prostatic cancer, and four of the ten patients with seemingly stage B disease were found to have seminal vesicle involvement. Tumor response to endocrine therapy can be objectively monitored, but tumor reactivation often goes undetected. Because the technique does not reliably differentiate carcinoma, chronic inflammation, and calculi, the use of transrectal ultrasonography in the screening of asymptomatic patients in an effort to detect early carcinoma appears to be of limited value.