Significance of suspicious lesions at transrectal ultrasonography in men with serum prostate-specific antigen levels of <20 ng/ml

Aims and background: The objective of the study was to evaluate the significance of suspicious lesions at transrectal ultrasonography for prostate cancer diagnosis. Patients and methods: A total of 1,009 men with a mean age of 65.0 +/- 7.7 years (range, 40.0-79.0) constituted the study cohort and 265 (26.3%) were diagnosed with prostate cancer on initial biopsy. Results: The cancer detection rate was higher in patients with suspicious lesions (33.2%) than in those with no suspicious lesion (21.5%) (P < 0.001). Pathologic findings of the needle biopsy samples also showed more aggressive characteristics in men with suspicious lesions (P < 0.05). Of 413 men with suspicious lesions, additional lesion-directed biopsies were performed in 133 patients. The positive predictive value of additional lesion-directed biopsy was 18.0%. Of patients who had positive cores on lesion-directed biopsies, all were also found to have positive cores on random biopsies, and no patient had positive cores only on lesion-directed biopsies. The Gleason score was not changed by the findings of lesion-directed biopsies in these patients. Conclusions: Our findings do not provide a rationale to recommend the addition of lesion-directed biopsy in patients with suspicious lesions at transrectal ultrasonography. However, men with suspicious lesions at transrectal ultrasonography had a higher risk of being diagnosed with prostate cancer.