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TRUS and prostate biopsy: current status

Prostate Cancer and Prostatic Diseases volume 7, pages 208–210 (2004)Cite this article

Since its widespread clinical application in the late 1980 s transrectal ultrasound (TRUS) has improved to the stage where the gland can be examined with submillimeter precision. Anatomical accuracy, however, has not significantly improved diagnostic accuracy of prostate cancer. Early reports of prostate cancer maintained that cancers were hyperechoic on US, later followed by reports that most cancers were in fact hypoechoic and yet more modern data hold that the many cancers are isoechoic and indistinguishable from normal prostate tissue. This experience parallels the downward stage migration of prostate cancer at presentation. Visibility of a prostate cancer depends on extra tissue interfaces presented by tumour disorganisation or the surrounding tissue reaction induced by the cancer. Thus, advanced cancers are often hyperechoic, earlier cancers are distinguished by greater inflammatory or vascular reaction and are seen as hypoechoic areas whereas the earliest tumours are histologically bland with barely any surrounding reaction and thus are isoechoic, or effectively invisible, on current grey-scale ultrasound. With the increasing use of PSA testing, what may be called de facto screening, most prostate cancers present at an earlier, and therefore ultrasound invisible stage.

Thus, the central dilemma of modern prostate cancer diagnosis using TRUS is how to diagnose isoechoic cancers. Broadly, two separate strategies are being explored to improve the recognition of early, small volume tumours. The first is the use of more biopsies per gland and the second is to improve our ability to visualise subtle tissue abnormalities.

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  1. Department of Radiology, St George's Hospital, UK

    U Patel

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Correspondence to U Patel.

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Patel, U. TRUS and prostate biopsy: current status. Prostate Cancer Prostatic Dis 7, 208–210 (2004). https://doi.org/10.1038/sj.pcan.4500728

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