Two hundred and sixteen patients, presenting with a suspicious digital examination (stage T(3) excluded) or a level of prostate-specific antigen (PSA) greater than or equal to 2.5 ng/ml, assessed by radioimmunoassay, underwent a trans- rectal ultrasound examination. Prostate volume was systematically calculated and correlated to PSA level. Biopsies were performed: (1) on suspicious peripheral hypoechoic areas: ultrasound-guided biopsies; (2) systematically on the 2 prostate lobes, whatever the result of transrectal ultrasound imaging:ran- dom systematic ultrasound-guided biopsies. In the 186 patients who had never undergone prostate surgery, ulstrasound-guided biopsies showed 42 prostate cancers and random systematic ultrasound-guided biopsies showec 75; 14 of the 76 patients with normal digital rectal examination and transrec tal ultrasound imaging had a prostate cancer. In the 30 patients who had pre viously undergone surgery for benign prostatic hypertrophy, random system atic ultrasound-guided biopsies showed 18 prostate cancers, 13% more tha ultrasound-guided biopsies; 75% of patients with a serum PSA > 5 ng/ml ha a prostate cancer. A very significant correlation was found between PSA lev and prostatic volume (p < 0.001). These results suggest that: (1) morbidity < random systematic ultrasound-guided biopsies is low; (2) random systemat ultrasound-guided biopsies permit the detection of 17% additional prosta cancers in relation to ultrasound-guided biopsies and 62 % of prostate canee if digital rectal examination was suspicious; (3) 18% of prostate cancers hac normal digital rectal examination and transrectal ultrasound imaging a( were detected only by means of random systematic ultrasound-guided bit sies performed in view of an isolated rise in PSA level which was not cor lated to prostate volume; (4) random systematic ultrasound-guided biop: detect prostate cancer with a significant volume.

Keywords:
Prostate cancer, Random biopsies, Prostate-specific antigen, Prostate volume
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1992
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