Transrectal ultrasound in the staging of clinical T3a prostate cancer

IntroductionThe clinical staging of T3a prostate cancer is usually based on digital rectal examination (DRE). Overstaging of clinical T3a prostate cancer is present in 13–27% of the cases presented and understaging is in the range of 30%. The value of transrectal ultrasound (TRUS) as a staging tool is not generally accepted. The purpose of this study is to determine whether TRUS can refine the local staging in unilateral clinical T3a (cT3a) prostate cancer.Patients and methodsBetween 1987 and 2004, 200 patients were staged as unilateral cT3a prostate cancer by DRE. All patients underwent radical prostatectomy and bilateral pelvic lymphadenectomy. Preoperative TRUS staging was performed for all patients. Final histopathological staging was compared with DRE and TRUS staging. The operable group (OG) was defined as T2 to unilateral T3a, and the advanced group (AG) was defined as bilateral T3a to T4.ResultsAll DRE patients were assumed operable. However, in this group histopathology showed 27.0% of the patients had advanced disease. TRUS confirmed 184 patients to be operable (140 having unilateral cT3a, 44 patients having cT1c to cT2). Sixteen patients were considered to have advanced disease by TRUS. Importantly, in this group, 68.7% of the cases were indeed confirmed to have advanced disease by histopathology.ConclusionTRUS can be used to refine clinical staging in unilateral cT3a prostate cancer. In cases where TRUS indicates advanced disease, it might be wise to trust the TRUS staging, rather than the DRE.