Urology Department, Urology and Nephrology Center, Mansoura, Egypt.

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The aim of the investigation was to identify the diagnostic importance of peripheral zone sonographic findings in correlation with total prostatic specific antigen (tPSA) and pathological findings.

Between January 2005 and January 2007, the transrectal biopsy records of 407 patients were reviewed for different prostatic indications. Echogenicity, calcific, and cystic changes of the peripheral zone were correlated with tPSA, total volume of the gland, digital rectal exam (DRE), and pathological findings.

The patients were divided into 3 groups (A, B, and C) according to tPSA: < 4 ng/mL (n = 19), 4-10 ng/mL (n = 159), and >10 ng/mL (n = 229), respectively. Heterogenicity was detected in 59.9% of cases and was higher when tPSA increased. Heterogenicity was found in the malignant biopsies of 78.7% of the patients (sensitivity = 78.78%; specificity = 44.6%). Calcific changes were found in 52% (n = 90) of group C (P < .05). Calcification was demonstrated in 41.4% (n=41) of malignant findings, but group comparisons were not statistically significant (sensitivity = 41.4%; specificity = 55.5%). Cystic changes were detected in 7.1% (n = 7) of malignant findings, but group comparisons were not statistically significant (sensitivity = 7.1%; specificity = 9.1%). However, 10.3% (n = 23) of patients with cystic peripheral zonal changes had high but not statistically significant PSA.

Heterogenicity of the peripheral zone is correlated with malignant pathology (positive predictor value = 31.9%) and high tPSA. Whenever a peripheral zone calcific change in prostatic sonography occurs, the urologist should suspect an increase of tPSA but without characteristic indicator of malignant anticipations (positive predictor value = 23.03%). Cystic changes in the peripheral zone are not specific findings and do not reflect any changes in tPSA or prostatic pathology.

Written by:
Ibrahiem EI, Hekal IA, Mohsen T.   Are you the author?

Reference:
UroToday Int J. 2009 Jun;2(3).
doi:10.3834/uij.1944-5784.2009.06.05

UroToday.com Prostate Cancer Section

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