Relationship of ultrasonographic findings to histology in prostate cancer

We compared ultrasonic findings and histology in 25 patients with prostate cancer. Ultrasonically guided transperineal biopsy of focal prostatic lesions was performed in 19 patients, in whom prostate cancer was suspected. Six of them had two different echogenic areas in the same focal lesion, so a total of 25 echogenic areas were assessed. Fourteen of these 25 areas were hypoechoic. The Gleason score varied, but residual prostatic glands and cancer glands with slightly enlarged lumen did not exist. Six of the areas were slightly more echogenic than the above 14 areas, and cribriform cancer with slightly enlarged glands occupied the greater part of these specimens. Four of the areas were isoechoic, and they contained residual prostatic glands showing a normal distribution, regardless of the Gleason score or grade of tumor infiltration. The only hyperechoic lesion contained numerous tiny areas of calcification. In the 6 patients without focal lesions, the peripheral and transition zones showed a normal echogenicity. Two of these patients had cancer in the transition zone, and biopsy showed tumor glands with slightly enlarged lumens. In the 4 patients, various-sized tumors were seen, but there was a normal distribution of residual prostatic glands and stroma. These results indicated that prostatic echogenicity is determined by the presence of tumor glands with enlarged lumina as well as residual prostatic glands and stroma.