Value of transrectal ultrasound in identifying local disease after radical prostatectomy

Transrectal ultrasound was performed on 15 men with clinical suspicion of local disease after radical retropubic prostatectomy. Clinical suspicion was defined as an elevation in serial serum prostate-specific antigen (PSA, above 0.4 ng/mL, Tandem-R + Assay) and/or palpable mass in the rectal vault. Post-radical prostatectomy ultrasound was normal if there was smooth tapering of the bladder neck to the urethra with no foci of variable echogenicity, and suspicious if any hyper- or hypo-echoic foci were present or if a mass was detected. Thirteen of 15 ultrasounds (87%) were described as suspicious while 2 of 15 (13%) were described as normal. Only 6 of 13 patients (46%) with suspicious findings on ultrasound had biopsy-proved carcinoma. Both patients with normal findings on post-radical prostatectomy ultrasound had biopsy-proved cancer. Transrectal ultrasound of the prostatic fossa when used independently is of no value in the diagnosis of local disease after radical prostatectomy. Transrectal ultrasound may help to direct systematic biopsies of the prostatic fossa in those patients in whom local disease is suspected on the basis of elevated serum PSA and/or a mass found on rectal examination.