Radical prostatectomy: Transrectal sonographic evaluation to assess for local recurrence

PURPOSE: To determine sonographic features associated with locally recurrent or residual tumor. MATERIALS AND METHODS: Twenty-three transrectal ultrasound (TRUS) studies were performed in 21 patients with suspected recurrent prostatic carcinoma after prostatectomy. The original prospective TRUS reports were reviewed, followed by blinded review, and the findings were compared with biopsy results. RESULTS: A discrete perianastomotic mass was identified prospectively in eight (73%) of 11 patients with positive biopsy results and in two (17%) of 12 with negative results; no mass was identified in the remaining patients. At preliminary retrospective review, the echogenic retroanastomotic fat plane was not intact in 10 (91%) of 11 patients with positive biopsy results and in two (17%) of 12 with negative results; it was intact in the remaining patients. CONCLUSION: Sonographic visualization of a mass in the prostate bed or loss of integrity of the retroanastomotic fat plane is strongly correlated with finding recurrent or residual tumor in this location. TRUS in evaluation of the source of postoperative elevation of prostate-specific antigen levels warrants further investigation.