Focal lesion at the midline of the prostate on transrectal ultrasonography: take it or leave it?

The purpose of this study was to analyze the detection rate of prostate cancers from targeted biopsy specimens of midline focal lesions and to investigate the ultrasonographic findings to reduce unnecessary additional targeted biopsies.

Ninety-eight men with midline focal lesions detected on transrectal ultrasonography were enrolled. Additional targeted biopsies for midline focal lesions were performed after 12- core random systematic biopsies. Correlations between the ultrasonographic characteristics of midline focal lesions and the pathologic results were analyzed.

Twenty of 98 targeted biopsy cores (20.4%) were positive for malignancy. In a univariate analysis, midline focal lesions without bulging contours, with involved margins, without hypoechoic perilesional rims, and with longer diameters were statistically significant for cancer detection. In a multivariate analysis, midline focal lesions with involved margins and longer diameters, but lacking hypoechoic perilesional rims, made a statistically significant contribution to cancer detection.

Biopsy of midline focal lesions was not always non-significant in the detection of prostate cancer. Additional targeted biopsies should be considered in cases of midline focal lesions with involved margins but without hypoechoic perilesional rims.

Ultrasonography (Seoul, Korea). 2016 May 16 [Epub ahead of print]

Junwoo Kim, Sung Il Hwang, Hak Jong Lee, Sung Kyu Hong, Seok-Soo Byun, Sangchul Lee, Gheeyoung Choe

Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea., Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea., Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea., Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea., Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea., Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea., Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea.

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