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CC BY-NC-ND 4.0 · South Asian J Cancer 2021; 10(03): 155-160
DOI: 10.1055/s-0041-1731906
Original Article: Genito Urinary Cancer

Hypoehoic lesions on Transrectal Ultrasound and its correlation to Gleason grade in the diagnosis of Clinically Significant Prostate Cancer: A Prospective Study

Manas Sharma
1   Department of Urology, JN Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
,
Rajendra B. Nerli
1   Department of Urology, JN Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
,
Sree Harsha Nutalapati
1   Department of Urology, JN Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
,
Shridhar C. Ghagane
2   Department of Urology, KLES Kidney Foundation, Urinary Biomarkers Research Centre, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India
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Abstract

Context The importance of hypoechoic lesions on transrectal ultrasound (TRUS) merits re-assessment in the present era of widespread prostate-specific antigen (PSA) testing.

Aims We aimed to investigate the predictive accuracy of hypoechoic lesions on TRUS of prostate in the diagnosis of prostate cancer and to examine the association of hypoechoic lesions with the aggressiveness of prostate cancer.

Settings and Design This prospective study was conducted in a tertiary care center in South India from November 2017 to December 2019.

Methods and Material We included 151 patients undergoing TRUS-guided 12-core prostate biopsy in view of raised serum PSA with or without suspicious digital rectal examination (DRE) findings in the study. Age, DRE findings, serum PSA level, TRUS findings, and histopathology reports were documented. These were compared between patients with and without hypoechoic lesions on TRUS.

Statistical Analysis Used The statistical analysis for this study was performed using SPSS v20.0 software.

Results Among 151 men, prostate cancer was diagnosed in 68 (45.03%) with mean age at presentation 69.81 ± 6.49 years. Fifty-eight cases (38.41%) had hypoechoic lesion on TRUS and the cancer detection rate (68.96%) amongst this group was significantly higher than in those without hypoechoic lesion (p <0.0001). Patients with hypoechoic lesion were more likely to have higher grade cancer. Abnormal DRE findings and hypoechoic lesion on TRUS were independent predictors of a clinically significant cancer (p <0.05).

Conclusion Hypoechoic lesion on TRUS can be considered as an indicator of clinically significant prostate cancer.

Keywords

prostate cancer - transrectal ultrasonography - prostate biopsy - hypoechoic lesion


Publication History

Article published online:
11 November 2021

© 2021. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010; 127 (12) 2893-2917
    CrossrefPubMedGoogle Scholar
  • 2 Ferlay J, Colombet M, Soerjomataram I. et al Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer 2019; 144 (08) 1941-1953
    CrossrefPubMedGoogle Scholar
  • 3 Hariharan K, Padmanabha V. Demography and disease characteristics of prostate cancer in India. Indian J Urol 2016; 32 (02) 103-108
    CrossrefPubMedGoogle Scholar
  • 4 E.H. News Bureau. ICMR releases data on incidence rate of prostate cancer in India. Express Health Care. 2019. Available at: https://www.expresshealthcare.in/news/icmr-releases-data-on-incidence-rate-of-prostate-cancer-in-india/414265. Accessed April 2, 2020
  • 5 Ghagane SC, Nerli RB, Hiremath MB, Wagh AT, Magdum PV. Incidence of prostate cancer at a single tertiary care center in North Karnataka. Indian J Cancer 2016; 53 (03) 429-431
    CrossrefPubMedGoogle Scholar
  • 6 Harvey CJ, Pilcher J, Richenberg J, Patel U, Frauscher F. Applications of transrectal ultrasound in prostate cancer. Br J Radiol 2012; 85 (Spec No 1) S3-S17
    CrossrefPubMedGoogle Scholar
  • 7 Gosselaar C, Roobol MJ, Roemeling S, Wolters T, van Leenders GJ, Schröder FH. The value of an additional hypoechoic lesion-directed biopsy core for detecting prostate cancer. BJU Int 2008; 101 (06) 685-690
    CrossrefPubMedGoogle Scholar
  • 8 Epstein JI, Walsh PC, Carmichael M, Brendler CB. Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA 1994; 271 (05) 368-374
    CrossrefPubMedGoogle Scholar
  • 9 Bastian PJ, Mangold LA, Epstein JI, Partin AW. Characteristics of insignificant clinical T1c prostate tumors. A contemporary analysis. Cancer 2004; 101 (09) 2001-2005
    CrossrefPubMedGoogle Scholar
  • 10 Andriole GL, Crawford ED, Grubb III RL. et al PLCO Project Team. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med 2009; 360 (13) 1310-1319
    CrossrefPubMedGoogle Scholar
  • 11 Roobol MJ, Kranse R, Bangma CH. et al ERSPC Rotterdam Study Group. Screening for prostate cancer: results of the Rotterdam section of the European randomized study of screening for prostate cancer. Eur Urol 2013; 64 (04) 530-539
    CrossrefPubMedGoogle Scholar
  • 12 Dubey D. The routine use of prostate-specific antigen for early detection of cancer prostate in India: is it justified?. Indian J Urol 2009; 25 (02) 177-184
    CrossrefPubMedGoogle Scholar
  • 13 Heijmink SW, van H Moerkerk, Kiemeney LA, Witjes JA, Frauscher F, Barentsz JO. A comparison of the diagnostic performance of systematic versus ultrasound-guided biopsies of prostate cancer. Eur Radiol 2006; 16 (04) 927-938
    CrossrefPubMedGoogle Scholar
  • 14 Onur R, Littrup PJ, Pontes JE. Bianco FJ Jr. Contemporary impact of transrectal ultrasound lesions for prostate cancer detection. J Urol 2004; 172 (02) 512-514
    CrossrefPubMedGoogle Scholar
  • 15 Toi A, Neill MG, Lockwood GA, Sweet JM, Tammsalu LA, Fleshner NE. The continuing importance of transrectal ultrasound identification of prostatic lesions. J Urol 2007; 177 (02) 516-520
    CrossrefPubMedGoogle Scholar
  • 16 Kuligowska E, Barish MA, Fenlon HM, Blake M. Predictors of prostate carcinoma: accuracy of gray-scale and color Doppler US and serum markers. Radiology 2001; 220 (03) 757-764
    CrossrefPubMedGoogle Scholar
  • 17 Egawa S, Wheeler TM, Greene DR, Scardino PT. Unusual hyperechoic appearance of prostate cancer on transrectal ultrasonography. Br J Urol 1992; 69 (02) 169-174
    CrossrefPubMedGoogle Scholar
  • 18 Malik R, Pandya VK, Naik D. Transrectal ultrasonography for evaluation of various benign and malignant prostatic lesions and their histopathological correlation. Indian J Radiol Imaging 2004; 14: 155-157
    Google Scholar
  • 19 Alan JW, Louis RK, Alan WP, Craig AP. Campbell-Walsh Urology. 11th ed. Elsevier 2016: 2582
  • 20 Xu G, Yao M, Wu J. et al Diagnostic value of different systematic prostate biopsy methods in the detection of prostate cancer with ultrasonographic hypoechoic lesions—a comparative study. Urol Int 2015; 95 (02) 183-188
    CrossrefPubMedGoogle Scholar
  • 21 Nesrallah L, Nesrallah A, Antunes AA, Leite KR, Srougi M. The role of extended prostate biopsy on prostate cancer detection rate: a study performed on the bench. Int Braz J Urol 2008; 34 (05) 563-570 discussion 570–571
    CrossrefPubMedGoogle Scholar
  • 22 Noh TI, Shin YS, Shim JS. et al Are hypoechoic lesions on transrectal ultrasonography a marker for clinically significant prostate cancer?. Korean J Urol 2013; 54 (10) 666-670
    CrossrefPubMedGoogle Scholar
  • 23 Yang T, Zhang L, Chen Y, Cai Y, Jiang H, Ding Q. The predictive efficacy of hypoechoic lesion in ultrasound for prostate cancer in Chinese people: five-year experience in a moderated 10-core transperineal prostate biopsy procedure. Oncotarget 2017; 8 (45) 79433-79440
    CrossrefPubMedGoogle Scholar
  • 24 Gosselaar C, Roobol MJ, Roemeling S, van der Kwast TH, Schröder FH. Screening for prostate cancer at low PSA range: the impact of digital rectal examination on tumor incidence and tumor characteristics. Prostate 2007; 67 (02) 154-161
    CrossrefPubMedGoogle Scholar
  • 25 Gosselaar C, Roobol MJ, Roemeling S, Schröder FH. The role of the digital rectal examination in subsequent screening visits in the European randomized study of screening for prostate cancer (ERSPC), Rotterdam. Eur Urol 2008; 54 (03) 581-588
    CrossrefPubMedGoogle Scholar
  • 26 Okotie OT, Roehl KA, Han M, Loeb S, Gashti SN, Catalona WJ. Characteristics of prostate cancer detected by digital rectal examination only. Urology 2007; 70 (06) 1117-1120
    CrossrefPubMedGoogle Scholar
  • 27 Patel U. The prostate and seminal vesicles. In: Allan P, Baxter G, Weston M, eds. Clinical Ultrasound. 3rd ed. Edinburgh: Churchill-Livingstone 2011: 572-592
  • 28 Wegelin O, van Melick HH, Hooft L. et al Comparing three different techniques for magnetic resonance imaging-targeted prostate biopsies: a systematic review of in-bore versus magnetic resonance imaging-transrectal ultrasound fusion versus cognitive registration. is there a preferred technique?. Eur Urol 2017; 71 (04) 517-531
    CrossrefPubMedGoogle Scholar