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.