Zusammenfassung
Einleitung: Die Prostatasextantenbiopsie gilt als Goldstandard in der invasiven Diagnostik des
Prostatakarzinoms. Die Vorhersagekraft des konventionellen transrektalen Ultraschalls
bleibt bislang unklar. Dies wird durch die vorliegende Studie prospektiv untersucht.
Material und Methodik: Im Universitätsklinikum Benjamin Franklin der FU-Berlin wird eine ultraschallgesteuerte
Zehnfachbiopsie der Prostata durchgeführt. Im Rahmen der vorliegenden Studie wurde
das Echo im TRUS für jede Biopsie bestimmt und mit dem histologischen Befund korreliert.
Unterschieden wurde zwischen folgenden Ultraschallsignalen: homogen, echoreich, echoarm,
zystisch und gemischt. Ergebnisse: Zwischen Januar 2000 und Februar 2001 wurden 187 Patienten mit geplanter Zehnfachbiopsie
der Prostata in die Studie aufgenommen. In allen Fällen fanden sich auswertbare Ergebnisse.
Bei 49/66 (74,2 %) der Karzinompatienten zeigten sich suspekte Signale im TRUS, bei
34/66 (51,5 %) war der digital-rektale Befund klärungsbedürftig, bei 62/66 (93,9 %)
bestand ein erhöhtes PSA. Nur bei 2/66 (3 %) Karzinompatienten lagen neben dem nichthomogenen
TRUS keine weiteren Hinweise (DRU, PSA) auf eine Malignität vor. Innerhalb der Gruppe
der Patienten mit benignen Erkrankungen lag bei 99/122 (81,1 %) ein auffälliger Ultraschallbefund
vor. Insgesamt wurden 1841 histologische Befunde mit dem jeweiligen TRUS-Signal in
Beziehung gesetzt. Es bestand keinerlei signifikante Korrelation zwischen einem Ultraschallsignal
und einem histologischen Ergebnis. Weder eine Malignität, noch eine benigne Erkrankung
ließ sich durch das Ultraschallsignal allein vorhersagen. Fazit: Die Sensitiviät des konventionellen TRUS zur Detektion eines Prostatakarzinoms liegt
bei 15 %, die Spezifität bei 84 %. Es besteht keinerlei signifikante Korrelation zwischen
TRUS-Signal und histologischem Befund. Der konventionelle transrektale Ultraschall
ist daher nicht zur Vorhersage der Histologie geeignet.
Abstract
Introduction: The prostate sextant biopsy is regarded as the gold standard of invasive prostate
cancer diagnostics. The unclear prognostic value of conventional transrectal ultrasound
is examined in this prospective study. Material and Method: Ultrasound-guided 10-core prostate biopsies are performed at the University Hospital
Benjamin Franklin of the Free University of Berlin. In this study, the TRUS echo was
determined for each biopsy and correlated with the histological findings. The following
ultrasound signals were differentiated: homogeneous, hyperechoic, hypoechoic, cystic
and mixed. Results: Between January 2000 and February 2001, 187 patients scheduled for a 10-core prostate
biopsy were included in the study. Results were assessable in all cases. TRUS signals
were suspicious in 49/66 (74.2 %) of the cancer patients, while 34/66 (51.5 %) had
unclear digital rectal findings and 62/66 (93.9 %) an elevated PSA. Only 2/66 (3 %)
cancer patients had no indications (DRU, PSA) of malignancy other than the nonhomogeneous
TRUS. Ultrasound findings were irregular in 99/122 (81.1 %) of the patients with benign
diseases. A total of 1841 histological findings were correlated with the respective
TRUS signal. No significant correlation was found between an ultrasound signal and
a histological result. Neither malignancies nor benign diseases could be predicted
by the ultrasound signal alone. Conclusion: Conventional TRUS has a 15 % sensitivity and an 84 % specificity for detecting prostate
cancer. There is no significant correlation between the TRUS signal and histological
findings. Thus, conventional transrectal ultrasound is not suitable for predicting
histology.
Schlüsselwörter
Prostata - Biopsie - TRUS - Histologie
Key words
prostate - biopsy - TRUS - histology
Literatur
- 1
Lee F, Torp-Pedersen S T, Siders D B.
Use of transrectal ultrasound in diagnosis, guided biopsy, staging, and screening
of prostate cancer.
Urology.
1989;
33
7-12
- 2
Nakagawa S, Watanabe M, Nomoto T. et al .
Mass screening for prostatic cancer.
Hinyokika Kiyo.
1997;
43
447-452
- 3
Imai K, Ogura H, Ichinose Y. et al .
The significance of six sextant biopsy for prostate cancer.
Nippon Hinyokika Gakkai Zasshi.
1994;
85
460-465
- 4
Ogawa O, Shichiri Y, Ohnishi H. et al .
Usefulness of ultrasound-guided prostate biopsy in the diagnosis and treatment of
localized prostate cancer.
Hinyokika Kiyo.
1996;
42
805-810
- 5
Hammerer P, Henke R P, Hubner D. et al .
Preoperative assessment of tumor aggressiveness in localized prostatic carcinoma.
Urologe A.
1995;
34
413-418
- 6
Wolff J M, Borchers H, Jakse G.
Determination of local tumour extension in cases of carcinoma of the prostate.
Arch Esp Urol.
1997;
50
546-553
- 7
Chen M E, Troncoso P, Johnston D A. et al .
Optimization of prostate biopsy strategy using computer based analysis.
J Urol.
1997;
158
2168-2175
- 8
Clements R, Aideyan O U, Griffiths G J. et al .
Side effects and patient acceptability of transrectal biopsy of the prostate.
Clin Radiol.
1993;
47
125-126
- 9
Crundwell M C, Cooke P W, Wallace D M.
Patients' tolerance of transrectal ultrasound-guided prostatic biopsy: an audit of
104 cases.
BJU Int.
1999;
83
792-795
- 10
Babaian R J, Toi A, Kamoi K. et al .
A comparative analysis of sextant and an extended 11-core multisite directed biopsy
strategy.
J Urol.
2000;
163
152-157
- 11
Yamamoto T, Ito K, Ohi M. et al .
Diagnostic significance of digital rectal examination and transrectal ultrasonography
in men with prostate-specific antigen levels of 4 NG/ML or less.
Urology.
2001;
58
994-998
- 12
Ciatto S, Bonardi R, Lombardi C. et al .
Predicting prostate biopsy outcome by findings at digital rectal examination, transrectal
ultrasonography, PSA, PSA density and free-to- total PSA ratio in a population-based
screening setting.
Int J Biol Markers.
2001;
16
179-182
- 13
Babaian R J, Dinney C P, Ramirez E I. et al .
Diagnostic testing for prostate cancer detection: less is best.
Urology.
1993;
41
421-425
- 14
Lee F, Torp-Pedersen S, Littrup P J. et al .
Hypoechoic lesions of the prostate: clinical relevance of tumor size, digital rectal
examination, and prostate-specific antigen.
Radiology.
1989;
170
29-32
- 15
Simak R, Eisenmenger M, Hainz A. et al .
Is transrectal ultrasonography needed to rule out prostatic cancer with normal findings
at digital rectal examination and normal serum prostate- specific antigen?.
Eur Urol.
1993;
24
474-478
- 16
Lee F, Torp-Pedersen S T, McLeary R D.
Diagnosis of prostate cancer by transrectal ultrasound.
Urol Clin North Am.
1989;
16
663-673
- 17
Renty P, D'Hauwers K, Van Camp C. et al .
Value of transrectal prostatic echography, prostate-specific antigen and rectal examination
in the diagnosis of prostate cancer. Relationship with the result of prostatic biopsies.
Acta Urol Belg.
1996;
64
7-12
- 18
Tang J, Li S, Xu J.
Transrectal ultrasound examination of the prostate in 100 cases of prostate cancer.
Zhonghua Zhong Liu Za Zhi.
2001;
23
228-229
- 19
Tzai T S, Lin J S, Yeh Y C. et al .
The role of transrectal ultrasonography on the palpable and impalpable abnormal prostate.
Eur Urol.
1995;
27
142-145
- 20
Oyen R H, van de Voorde W M, Van Poppel H P. et al .
Benign hyperplastic nodules that originate in the peripheral zone of the prostate
gland.
Radiology.
1993;
189
707-711
- 21
de la Rosette J J, Giesen R J, Huynen A L. et al .
Automated analysis and interpretation of transrectal ultrasonography images in patients
with prostatitis.
Eur Urol.
1995;
27
47-53
- 22
Grossfeld G D, Coakley F V.
Benign prostatic hyperplasia: clinical overview and value of diagnostic imaging.
Radiol Clin North Am.
2000;
38
31-47
- 23
Colombo T, Schips L, Augustin H. et al .
Value of transrectal ultrasound in preoperative staging of prostate cancer.
Minerva Urol Nefrol.
1999;
51
1-4
- 24
Rorvik J, Halvorsen O J, Servoll E. et al .
Transrectal ultrasonography to assess local extent of prostatic cancer before radical
prostatectomy.
Br J Urol.
1994;
73
65-69
- 25
Vijverberg P L, Giessen M C, Kurth K H. et al .
Is preoperative transrectal ultrasonography of value in localised prostatic carcinoma?
A blind comparative study between preoperative transrectal ultrasonography and the
histopathological radical prostatectomy specimen.
Eur J Surg Oncol.
1992;
18
449-455
- 26
Lee F, Bahn D K, Siders D B. et al .
The role of TRUS-guided biopsies for determination of internal and external spread
of prostate cancer.
Semin Urol Oncol.
1998;
16
129-136
- 27
Bogers H A, Sedelaar J P, Beerlage H P. et al .
Contrast-enhanced three-dimensional power Doppler angiography of the human prostate:
correlation with biopsy outcome.
Urology.
1999;
54
97-104
- 28
Okihara K, Kojima M, Nakanouchi T. et al .
Transrectal power Doppler imaging in the detection of prostate cancer.
BJU Int.
2000;
85
1053-1057
- 29
Maruzzi D, Marin A, Lenardon O. et al .
Color Doppler and ultrasound-guided prostate biopsy in the diagnosis of prostatic
neoplasm.
Arch Ital Urol Androl.
2000;
72
174-181
- 30
Chin J L, Downey D B, Elliot T L. et al .
Three dimensional transrectal ultrasound imaging of the prostate: initial experience
with an emerging technology.
Can J Urol.
1999;
6
720-726
- 31
Merkle W.
Colour Doppler Transrectal 3D-Sonography of the Prostate - First Experiences.
Aktuelle Urologie.
2002;
33
53-57
Dr. med. M. Schostak
Oberarzt der Urologischen Klinik und Poliklinik · Universitätsklinikum Benjamin Franklin
· Freie Universität Berlin
Hindenburgdamm 30
D-12200 Berlin
Phone: 030 8445-2577
Fax: 030 8445 4448
Email: martin.schostak@medizin.fu-berlin.de