The importance of tumor palpability and transrectal ultrasonographic appearance in the contemporary clinical staging of prostate cancer
An accurate assessment of the clinical stage of prostate cancer is important to determine the most appropriate treatments for patients. Most centers rely on digital rectal examination, given conflicting results in the literature regarding the role of transrectal ultrasonography (TRUS).Since ultrasound technologies as well as physician experience have improved, the contemporary impact of TRUS on the clinical staging of prostate cancer was assessed.In 2002, a standardized form to evaluate TRUS findings in order to rank the clinical suspicion of extracapsular extension (ECE) was used for all prostate cancer patients evaluated at UCSF. Preoperative clinical findings were compared with pathological staging as assessed by analysis of radical prostatectomy specimens from 2002 to 2007 (n = 620).Mean patient age was 58 ± 6.6 years with a mean PSA of 7.0 ± 4.5; 157/620 (25.3%) had pathologic ECE. Evidence of ECE by TRUS was associated with higher pathologic stage (P < 0.00001) and higher rates of biochemical failure after prostatectomy (P = 0.0006). Overall, TRUS had a 31% sensitivity, 92% specificity, 58% positive predictive value, and 80% negative predictive value with an area under the curve of 0.77 for the detection of ECE. TRUS alone was significantly more accurate in predicting ECE than commonly used nomograms or tables (P < 0.001) when examining patients with impalpable tumors.In the current era, TRUS provides an accurate method to assess a cancer stage.