Lymph node staging of localized prostatic carcinoma with CT and CT-guided fine-needle aspiration biopsy: prospective study of 285 patients.

PURPOSE: To ascertain the reliability of computed tomography (CT) and CT-guided fine-needle aspiration biopsy (FNAB) in staging of lymph nodes in patients with locally confined prostatic carcinoma. MATERIALS AND METHODS: A total of 285 patients were studied prospectively. FNAB was performed in 43 patients (15%) with lymph nodes suspect for metastasis on CT scans. FNAB findings were correlated with either the findings of the pathologic examination performed after lymph node dissection (LND) or the status of the lymph node at follow-up with CT after hormone therapy. RESULTS: The sensitivity, specificity, and accuracy of CT-guided FNAB were 77.8%, 100%, and 96.5%. If CT only had been performed, these results would have been 77.8%, 96.7%, and 93.7%. CT staging was false-negative in only 10 patients, who had microscopic metastatic deposits in a solitary lymph node. CONCLUSION: Combined CT and FNAB is highly efficient for assessment of lymph node metastasis. Therefore, it could be considered an alternative to surgical or laparoscopic lymphadenectomy in patients scheduled for radical prostatectomy or curative radiation therapy.

Benign hyperplastic nodules that originate in the peripheral zone of the prostate gland.

PURPOSE: To describe a benign nodular lesion in the peripheral zone (PZ) of the prostate gland. MATERIALS AND METHODS: In 1,087 patients, the features of 722 focal lesions in the PZ or central zone of the prostate on transrectal ultrasound (TRUS) scans were retrospectively compared with histologic findings in biopsy samples. RESULTS: In 18 patients (5.5% of the 328 patients with benign lesions), benign hyperplasia was found in a focal, nodular lesion obviously located within the PZ. On TRUS scans, the nodules were well circumscribed, ovoid or round, and slightly hypoechoic (n = 11) or isoechoic (n = 7). The isoechoic lesions were surrounded by an anechoic halo. One nodule was an incidental sonographic finding; the 17 others were felt as firm (n = 11) or soft (n = 6) at digital rectal examination. The ratio of serum prostate-specific antigen (PSA) level to prostatic volume was low (< 0.1), except in one patient (0.24). CONCLUSION: Some sonographic features and the normal PSA values might suggest a benign nodule in the PZ, but TRUS-guided biopsies and histologic correlation are necessary to confirm the diagnosis.