Transrectal US in evaluation of patients after radical prostatectomy. Part I. Normal postoperative anatomy.

The appearance of the prostatic fossa on transrectal ultrasound (TRUS) scans obtained after radical retropubic prostatectomy (RRP) was studied in 25 patients believed to have no tumor on the basis of their level of serum prostate-specific antigen (PSA) (< or = 0.4 ng/mL). The profile of the vesicourethral anastomosis (VUA) in the midsagittal plane was tapered in 13 patients (52%) and nontapered in 12 patients (48%). The nontapered profile was associated with incontinence in nine of 11 patients (82%) followed up for less than 12 months but in only four of 14 patients (28%) followed up beyond 1 year. In 20 patients (80%), a hypoechoic soft-tissue lesion (average volume, 1.7 cm3) was seen anterior to the VUA and indented the anterior bladder wall. The length of the urethral high-pressure zone increased with muscular contraction of the pelvic floor. Knowledge of the baseline anatomic structures depicted on TRUS scans obtained after RRP may be useful in selection of tissue for TRUS-guided needle biopsy in patients with elevated levels of PSA. The many post-surgical changes reduced the specificity of the TRUS findings.

Transrectal US in evaluation of patients after radical prostatectomy. Part II. Transrectal US and biopsy findings in the presence of residual and early recurrent prostatic cancer.

The anatomic appearance of the prostatic fossa on transrectal ultrasound (TRUS) scans obtained after radical retropubic prostatectomy (RRP) for carcinoma was studied in 16 patients in whom local recurrence was suspected on the basis of rising serum prostate-specific antigen (PSA) levels above 0.4 ng/mL, negative pelvic computed tomographic scans, and negative bone scans. Findings in samples obtained with ultrasound (US)-guided biopsy were compared with those in samples obtained with digitally guided biopsy (DGB); each patient was his own control. When the postoperative anatomic appearance on TRUS scans was compared with that in patients without suspected recurrence of cancer, no significant difference was seen. Needle biopsy was positive for carcinoma in eight patients (50%): US-guided biopsy, in seven patients; DGB, in five patients; and both US-guided biopsy and DGB, in four patients. US-guided biopsy has limited usefulness over DGB in patients with rising PSA levels after RRP, but use of both DGB and US-guided biopsy may maximize sensitivity. The main value of TRUS may be in accurate positioning of the biopsy needle about the vesicourethral anastomosis.