Local relapse of the prostate cancer following radical prostatectomy. Transrectal ultrasound diagnosis

Abstract

Research purpose. Investigate possibilities of the transrectal ultrasonography (TRUS) in early diagnostics of the local recurrence of the prostate cancer (PC) following radical prostatectomy (RPE).
Materials and methods. 50 PC patients at the age of 52–73 years (mean age – 62,5 years) that have undergone RPE in different clinics were under our observation. Preoperational prostate-specific antigen (PSA) value mounted 1,7–30 ng/ml. The following stages were determined clinically: Т1N0M0 – 8 patients, Т2N0M0 – 42 patients (Т2а – 38, Т2b – 2, T2c – 2). Following RPE, a positive surgical edge was revealed in 7 patients, tumor invasion to the seminal vesicles – in 3. After performed RPE, PSA level was determined 1 time per 3 months and TRUS in B-mode using energetic mapping (EM) was performed in all the patients. For this, MEDISON company SonoAce 8800 device with convex intracavitary sensor with a frequency 7,5 MHz was used.
Results. In 1,5 years after RPE, PSA level increase more then 0,2 ng/ml (0,58–28 ng/ml) was observed. Patients have been examined, including: digital rectal investigation (DRI), TRUS of the prostate bed, helical computed tomography (HCT) of the minor pelvis organs, skeleton scintigraphy. DRI revealed a hardening part in 1 patient, bone metastatic lesion in 2 patients. Via HCT of the minor pelvis organs, a pathologic structure in the prostate bed region with invasion of the posterior bladder wall was revealed. By B-mode TRUS using EM, the areas of solid structure in the region of vesico-urethral anastomosis or behind the posterior bladder wall were revealed in 9 patients, including hypoechogenic with deformed coiled vessels – in 6, isoechogenic with solitary signals by EM – in 2, mixed echogenicity with the posterior bladder wall invasion – in 1 patients. By histological examination of the biopsy materials from the doubtful regions, the PC recurrence is diagnosed in 8 patients, in 1 – histologically local PC recurrence has not been confirmed.
Conclusions. TRUS with using EM – is a higly informative, economically and clinically significant method of early diagnostics of the local PC recurrence following RPE.