R. Clements

Side effects and patient acceptability of transrectal biopsy of the prostate

The side effects and patient acceptability of 230 ultrasound guided prostatic needle biopsies performed by the transrectal route in an out-patient setting were reviewed retrospectively. Most of the side effects were transient and mild; one patient required hospitalization for urinary retention. Patient acceptability was good; over 70% of patients reported no significant pain from the biopsy procedure.

Prostate MRI: Who, when, and how? Report from a UK consensus meeting

The current pathway for men suspected of having prostate cancer [transrectal biopsy, followed in some cases by magnetic resonance imaging (MRI) for staging] results in over-diagnosis of insignificant tumours, and systematically misses disease in the anterior prostate. Multiparametric MRI has the potential to change this pathway, and if performed before biopsy, might enable the exclusion of significant disease in some men without biopsy, targeted biopsy in others, and improvements in the performance of active surveillance. For the potential benefits to be realized, the setting of standards is vital. This article summarizes the outcome of a meeting of UK radiologists, at which a consensus was achieved on (1) the indications for MRI, (2) the conduct of the scan, (3) a method and template for reporting, and (4) minimum standards for radiologists.

Transrectal ultrasound in the investigation of haemospermia

The transrectal ultrasound findings in 52 patients with haemospermia were reviewed. Scan abnormalities were demonstrated in 43 patients (83%). These included benign prostatic hyperplasia (24 patients), seminal vesicle abnormalities (10 patients), prostatic calcification (32 patients) and two patients with prostatitis. No patient was proven to have prostatic malignancy. Transrectal ultrasonography can suggest a cause of haemospermia in the majority of patients without resort to invasive investigations, and can exclude underlying prostatic malignancy. It is recommended as the first radiological investigation in patients presenting with haemospermia.

Transrectal ultrasound appearances of granulomatous prostatitis

Granulomatous prostatitis is an unusual, but well-recognized entity frequently mistaken for carcinoma on both digital rectal examination and transrectal ultrasound. The ultrasonographic findings of 11 patients with histologically-proven granulomatous prostatitis are reviewed.

The changing role of transrectal ultrasound in the diagnosis of prostate cancer

Prostatic cancer is common, being the second most frequent cause of death from cancer in men in the United Kingdom. It is a disease with an unpredictable course, and this unpredictability causes controversy for diagnosis and treatment. There have been two major developments in techniques to diagnose prostate cancer in the last 20 years, namely transrectal ultrasound (TRUS) and serum prostate specific antigen (PSA) measurements, but it is only recently that the relative roles of these techniques in the diagnosis of prostate cancer have started to become clearer. TRUS was developed by Watanabe in the early 1970s [1] and was introduced into Europe by workers in South Wales in 1979. The original scanning equipment comprised a chair mounted probe with a 3.5 MHz transducer which could be raised and lowered within the rectum and produced axial images of the prostate. These early images were correlated with the histology of either the prostatic adenoma removed at open prostatectomy in patients with outflow tract obstruction, or the chippings obtained at a transurethral resection of the prostate. There was no precise correlation between any detected alterations in prostatic echogenicity and the histology, as it was not possible to perform ultrasound guided biopsy with this early equipment. It was only with the introduction of ultrasound guided transperineal biopsy of the prostate in the early 1980s that it became possible to correlate the sonographic appearances accurately with histology and obtain a true understanding of the sonographic features of prostate cancer. It became apparent that the predominant ultrasound appearance of prostatic cancer was as a hypoechoic area but that iso- and hyperechoic cancer could also occur [2,3]. Modern transducers use a higher frequency, e.g. between 5 and 10 MHz, and give greatly improved definition of the prostate, and ultrasound guided prostatic biopsies are now generally performed by the transrectal route during scanning. TRU.S may also be used in the assessment of patients with haemospermia, prostatitis and infertility, and TRUS guidance has become important recently in the treatment of prostate cancer by cryotherapy. The principal use of TRUS in the UK however remains the diagnosis of prostate cancer. Recent research with prostatic ultrasound has concentrated on the detection of early rather than advanced prostatic cancer. Research has centred on the integration of TRUS findings with digital rectal examination (DRE) and PSA levels in the development of biopsy strategies, together with the use