How Accurately Can Prostate Gland Imaging Measure the Prostate Gland Volume? Results of a Systematic Review

Table 1

Summary of articles measuring the PGV by TRUS in chronological order.

First author,; Year of publication,; Country	Number of patients,; Age	TRUS Imaging details,; Mean volume	Reference method,; Mean volume	Reference method details	Correlation; data	Concordance; Data and over/under estimation	Other; comments	Scores for Bias (0-2); and; Quality (0-4)
Wolff [12] 1995; Germany	25 pts, age NS	EC, Mean NS	Specimen weight, SGF applied, mean 36gm	SV weight subtracted	Linear regression R=0.83; P<0.0001	NS	Two methods of EC compared, NSD	B2; Q0
Tewari [13] 1996; USA	48 pts; Age NS	EC; mean 60gm	Weighed after fixation, SGF applied, mean 65 gm	SV removed	NS	Students t-test p=0.04; PGV was underestimated by about 10%	Also used MRI but not compared with reference.	B2; Q1
Matthews [14] 1996 USA	100 pts; Age NS	EC; Mean 36mL	Mean 45 mL; EC from measurements	Within 1 hr of excision	NS	Students t-test; P<0.01; PGV was underestimated if <30mL and overestimated if >30mL		B2; Q1
Zlotta [15] 1999; Belgium and Austria	36 pts; Age NS	EC; Mean 29 mL	Weighed; Mean 34 mL	Details NS	Pearson’s R=0.78; P<0.001	Students t-test p=0.004	TZ volume measurement was more accurate than whole prostate	B2; Q0
Park [16] 2000; South Korea	16 pts; Mean 62 yrs	EC, mean 30 mL transaxial and 33 mL midsagittal	EC from specimen, mean 32 mL	Within 1 hr of excision	0.71 Midsagittal; 0.83 Transaxial; Method NS	Student’s t-test NSD	AP measured in two planes, NSD	B2; Q1
Freedland [17] 2005 USA	753 pts; Age NS	Details NS	Weight, otherwise details NS	Included SV and vasa tips	Spearman r=0.71; P<0.001	NS	From a larger study of 1602 RP pts in the SEARCH database, mean age 63 yrs, mean specimen weight 44gm	B1; Q1
Loeb [18] 2005; USA	1844 pts; Mean 65 yrs	EC; Mean 40gm	Mean wt 50 gm	Included SV	Spearman’s; R=0.65	PGV was generally underestimated, more accurate with smaller PGV	TRUS better than DRE	B1; Q2
Cabello-Benevente [19] 2006 Spain	33 pts; Age NS	EC; Mean 39cc	Weight; 54 gm	Details NS	Pearson r=0.79	Student’s t-test; P=0.001; Underestimated by 29%		B2; Q1
Lee [20] 2006 Korea	73 pts, age NS	EC; Mean 39cc	Fresh weight within 1 hr, SGF applied, mean 37cc	SV removed	Pearson r=0.88; P< 0.001	Overestimated if <35cc, underestimated if >35cc	Also tested MRI, which was more accurate	B2; Q4
Sajadi [21] 2007 USA	497 pts; Mean 60yrs	EC; Mean 37.4cc	Specimen weight mean 45 gm	Fresh Weight included SV	Spearman’s; R=0.692, p<0.001	Usually underestimated	VA study	B1; Q3
Jeong [22] 2008 Korea	21 pts, mean 66 yrs	EC, Means 42-51 mL	Fresh specimen within 1 hr, displacement method, mean 40mL	SV removed	Linear regression, R=0.90-94	Students t-test; P=0.1-<0.001; Axial and midsagittal measurements of AP were compared, axial better for TRUS	Also used MRI with both EC and PC, where Midsagittal and PC most accurate	B2; Q3
Rodriguez [23] 2008 USA	124 pts; Age NS	EC; Mean NS	Displacement method and weight (together correlated 0.997).	Defatted but SV attached.	Correlations not given but only 24% within +/- 10%	Underestimated wt in all size categories	No mean values given	B1; Q2
Acer [24] 2010; Turkey	5 pts; Mean 60 yrs	EC Mean vol 43 cc	Fluid displacement; Mean 53 cc	SV removed	Kruskal Wallis; P = 0.677 (NSD)	21% underestimation		B2; Q2
Hong [25] 2012; Australia	236 pts; Mean 61 yrs	EC 37 mL	Weight post Formalin fixation; 46 mL	SV removed	Spearman r=0.74	Concordance coefficients also provided 0.31-0.46, considered poor	Also performed EC on specimens, median 32 mL, concluded weight more useful	B1; Q3
Varkarakis [26] 2013 Greece	60 pts mean 64 yrs	Both TRUS and SPUS Both EC, means 45-50 cc resp	Displacement of fresh specimen, mean 45 cc	SV and vas removed	NS	SPUS overestimated PGV, TRUS NSD	Also used CT	B2; Q2
Bienz [27] 2014; Canada and USA	440 pts; Age NS	EC; 4 Volume categories	Weighed before fixation	Details NS	Pearson improved with volume r = 0.17-0.84; P= 0.056-<0.01	ANOVA; PGV was underestimated <30 and overestimated >80cc, avg absolute error 39%	Median lobe made no difference	B2; Q3
Kilic [28] 2014 Turkey	163 pts, mean age 64 yrs	EC; TRUS and SPUS, means 51 and 50 mL respectively	Fresh weights, Mean 55 gm	SV included; SGF applied	ICC 0.84-0.90	Both TRUS and SPUS underestimated the PGV; TRUS slightly better than SPUS (NSD)	Also used CT, TRUS and SPUS more accurate	B2; Q2
Paterson [29] 2016 Canada	318 pts; Mean 63 yrs	EC; Mean 39cc	Fluid displacement method. Mean 37cc	Prostate weight also used (ICC=0.96)	ICC 0.74	Underestimated on average by 3cc	MRI slightly more accurate	B1; Q3

Pts: patients, Yrs: years of age, TRUS: transrectal ultrasound, SPUS: suprapubic ultrasound, EC: ellipsoid calculation, PC: planimetric calculation, NS: not stated, VA: Veterans Affairs, SV: seminal vesicles, TZ: transitional zone, MRI: magnetic resonance imaging, CT: computer tomography, AP: anteroposterior, ICC: intraclass correlation coefficient, SGF: specific gravity factor (1.05 g/mL), and SEARCH: shared equal access regional cancer hospital.