DIAGNOSIS OF PROSTATE ADENOCARCINOMA THROUGH ULTRASOUND-GUIDED TRANSRECTAL BIOPSY IN PATIENTS WITH PSA LEVELS BELOW 4.0NG/ML

ICONOGRAPHIC ESSAY - CASE SERIES

Abstract

INTRODUCTION: Currently, the diagnosis of prostate cancer is based on digital rectal examination, prostate-specific antigen (PSA) blood levels, and transrectal ultrasound (TRUS); however, none of them is sensitive and specific enough to be used alone in defining the conduct to be taken in relation to the patient. PSA is a simple diagnostic tool used in prostate cancer screening and TRUS is a method that can detect tumors at earlier stages. Technical advances with the introduction of color Doppler, an important adjuvant factor in the search for prostate cancer, better evaluating nodules and/or suspicious areas, have increased the positive predictive value of this test. The present iconographic essay aimed to illustrate a series of cases diagnosed with prostate adenocarcinoma in patients with PSA levels lower than or equal to 4.0 ng/ml and with abnormal digital rectal examination. CASE SERIES: Patients undergoing randomized sextant biopsy with conventional technique for diagnostic elucidation. The findings of hypoechoic nodule type in the peripheral zone, diffuse hypoechogenicity, loss of differentiation between the peripheral zone and the internal gland, focal bulges or asymmetry of the peripheral zone, irregularities and interruption of the prostatic capsule were considered as suspicious alterations of cancer on ultrasound. DISCUSSION: The cases presented confirm the importance of clinical examination through digital touch. All cases presented suspicious focal and/ or diffuse B-mode changes associated or not with suspicious changes on Doppler analysis. Ultrasonography is useful, as it allows performing, in addition to random biopsies, biopsies aimed at echographic alterations, which have a greater positive predictive value for carcinoma. Prostatic carcinoma needs tools that are precise enough to promote its early detection, thus allowing adequate treatment, improved survival and lower morbidity. CONCLUSION: The illustration of cases is a constant need in the training, continuing education and daily practice of urologists and sonographers.