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Wang Y, Li X, Yang H, Yin C, Wu Y, Chen X. Predictive factors of incidental prostate cancer in patients undergoing surgery for presumed benign prostatic hyperplasia: an updated systematic review and meta-analysis. Front Oncol 2025; 15:1561675. [PMID: 40083876 PMCID: PMC11903258 DOI: 10.3389/fonc.2025.1561675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Accepted: 02/13/2025] [Indexed: 03/16/2025] Open
Abstract
Purpose We aimed to identify the clinical predictors of incidental prostate cancer (IPCa) after surgery for presumed benign prostatic hyperplasia (BPH). Methods The literature was comprehensively searched using PubMed, Web of Science, Embase, and Cochrane databases in December 2024. We used pooled standardized mean difference (SMD) and odds ratio (OR) to describe the correlation between relevant risk factors and IPCa. Results Twenty-one studies included 10,842 patients that were available for further analysis. After BPH surgery, 957 patients were histopathologically diagnosed with IPCa. The IPCa rate was 8.83%. Most importantly, our results identified that IPCa was significantly associated with age (pooled SMD = 0.36, P < 0.001), body mass index (BMI) (pooled SMD = 0.23, P < 0.001), preoperative prostate-specific antigen (pre-PSA) (pooled SMD = 0.43, P < 0.001), preoperative prostate-specific antigen density (pre-PSAD) (pooled SMD = 0.62, P = 0.028), resected prostate weight (pooled SMD = -0.22, P < 0.001), preoperative treatment with 5-alpha reductase inhibitors (5αRIs) (yes/no) (pooled OR = 0.60, P < 0.001), family history (yes/no) (pooled OR = 3.81, P = 0.029), digital rectal examination (DRE) findings (abnormal/normal) (pooled OR = 5.15, P < 0.001), and transrectal ultrasonography (TRUS) findings (abnormal/normal) (pooled OR = 2.92, P < 0.001). Additionally, sensitivity and subgroup analyses indicated that our findings were reliable and robust. However, we found no significant associations between IPCa and prostate volume, preoperative negative prostate biopsy, smoking history, history of hypertension, history of diabetes, history of dyslipidemia, and abnormal magnetic resonance imaging findings (all P > 0.05). Conclusions Age, BMI, pre-PSA, pre-PSAD, resected prostate weight, preoperative treatment with 5αRIs, family history, abnormal DRE findings, and abnormal TRUS findings are independent factors predicting IPCa following BPH surgery. Before BPH surgery, factors such as age, BMI, pre-PSA, and pre-PSAD should be considered to assess the risk of IPCa. For high-risk patients, more detailed imaging and needle biopsy are recommended before surgery to avoid missed diagnosis. In the future, more large-scale and well-designed studies are needed to validate our results further. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42025631346.
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Affiliation(s)
- Yang Wang
- Department of Urology, Guangdong Provincial People’s Hospital, Zhuhai Hospital (Jinwan Central Hospital of Zhuhai), Zhuhai, China
| | - Xiancheng Li
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hua Yang
- Department of Urology, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Chaoshan Yin
- Department of Urology, Fuyang Hospital of Anhui Medical University, Fuyang, China
| | - Yameng Wu
- Department of Urology, Fuyang Hospital of Anhui Medical University, Fuyang, China
| | - Xiaoke Chen
- Department of Urology, Guangdong Provincial People’s Hospital, Zhuhai Hospital (Jinwan Central Hospital of Zhuhai), Zhuhai, China
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Chung JH, Park BK. Transrectal ultrasound features and biopsy outcomes of transition PI-RADS 5. Acta Radiol 2022; 63:559-565. [PMID: 34027681 DOI: 10.1177/02841851211018775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Transition Prostate Imaging and Reporting and Data System (PI-RADS) 5 is easily detected owing to typical magnetic resonance imaging features. However, it is unclear as to how transition PI-RADS 5 appears on transrectal ultrasound (TRUS). PURPOSE To assess TRUS features of transition PI-RADS 5 and outcomes of TRUS-guided target biopsy. MATERIAL AND METHODS Between March 2014 and November 2018, 186 male patients underwent TRUS-guided biopsy of PI-RADS 5. Of them, 82 and 104were transition and peripheral PI-RADS 5, respectively. Transition and peripheral PI-RADS 5 were compared according to echogenicity (hyperechoic or hypoechoic) and hypoechoic rim (present or absent). Each tumor was targeted with TRUS based on TRUS features. Significant (Gleason score ≥7) and insignificant (Gleason score 6) cancer detection rates (CDRs) were compared between transition and peripheral PI-RADS 5. Standard reference was biopsy examination. Fisher's exact test was used for statistical analysis. RESULTS Transition PI-RADS 5 was hyperechoic in 89.0% (73/82) and had a hypoechoic rim in 97.6% (80/82), whereas peripheral PI-RADS 5 was hypoechoic in 99.0% (103/104) and had a hypoechoic rim in 26.9% (28/104) (both, P<0.0001). The significant CDRs of transition and peripheral PI-RADS 5 were 56.1% (46/82) and 65.4% (68/104), respectively (P=0.2263). However, the insignificant CDRs of these categories were 22.0% (18/82) and 8.7% (9/104), respectively (P=0.0123). CONCLUSION Transition PI-RADS 5 tends to have hyperechoic echogenicity and a hypoechoic rim. These findings help to target the transition PI-RADS 5 using TRUS. However, transition PI-RADS 5 is confirmed more frequently as insignificant cancer than peripheral PI-RADS 5.
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Affiliation(s)
- Jae Hoon Chung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Pan CY, Wu B, Yao ZC, Zhu XQ, Jiang YZ, Bai S. Role of Hiraoka's transurethral detachment of the prostate combined with biopsy of the peripheral zone during the same session in patients with repeated negative biopsies in the diagnosis of prostate cancer. World J Clin Cases 2020; 8:2219-2226. [PMID: 32548152 PMCID: PMC7281050 DOI: 10.12998/wjcc.v8.i11.2219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/26/2020] [Accepted: 04/24/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Persistent suspicion of prostate cancer (PCa) due to a rising prostate-specific antigen (PSA) level after repeated negative biopsies is a serious challenge in clinical practice.
AIM To determine the role of Hiraoka’s transurethral detachment of the prostate (TUDP) combined with biopsy of the peripheral zone during the same session in patients with repeated negative biopsies in the diagnosis of PCa.
METHODS We retrospectively evaluated the records of 10 patients who were eligible for inclusion in our hospital between December 2012 and August 2017. Patient demographics, a family history of PCa, the number of biopsies, prostate volume, pathological examination, and perioperative PSA level were obtained.
RESULTS Two of 10 patients were pathologically diagnosed with PCa after surgery; the Gleason scores were 4 + 4 and 4 + 3, respectively. Both patients subsequently underwent laparoscopic radical prostatectomy. The median PSA levels preoperatively, and 3 mo and 1 year postoperatively in the other eight patients who were diagnosed with benign prostate hyperplasia after surgery were 19.10 ng/mL, 1.10 ng/mL, and 1.15 ng/mL, respectively. The adjusted P values of the 3-mo and 1-year post-operative PSA level vs pre-operative PSA level were 0.003 and 0.026, respectively. None of the patients had increased PSA levels or PCa detected after a median 35 mo of follow-up.
CONCLUSION TUDP combined with peripheral zone biopsy may improve the detection rate of PCa in patients with repeated negative biopsies. The PSA level declined rapidly in patients who had negative pathological examinations after TUDP, which remained stable 1 year after surgery.
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Affiliation(s)
- Chun-Yu Pan
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Bin Wu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Zi-Chuan Yao
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Xian-Qing Zhu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yun-Zhong Jiang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Song Bai
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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Kim KH, Kim SW, Son HS, Kim DK, Jung DC, Kim HW, Kim JC, Hong SJ, Kim JH. Role of Holmium laser enucleation of the prostate to increase cancer detection rate in patients with gray-zone PSA level. MINERVA UROL NEFROL 2018; 71:72-78. [PMID: 30037211 DOI: 10.23736/s0393-2249.18.03186-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Even though the safety of the treatment for prostate cancer diagnosed by HoLEP has been reported, the diagnostic value of HoLEP for prostate cancer detection has not been confirmed. Therefore, we investigated the diagnostic potential of HoLEP for detecting prostate cancer. METHODS Between December 2009 and October 2015, 359 patients (median age, 70.9 years; range, 66.2-74.8) were treated simultaneously with HoLEP and transrectal prostate needle biopsy (TPNB). Of these, 199 patients with a normal digital rectal examination and serum PSA concentration between 3.5 and 10.0 ng/mL were included in the study. Univariate and multivariate logistic regression analyses were performed to identify the predictive factor for prostate cancer detected by HoLEP. RESULTS Median PSA, prostate volume and PSA density were 4.97 ng/mL (range, 4.20-6.70), 57.40 gm (range, 43.67-77.80) and 0.09 ng/mL2 (range, 0.07-0.12), respectively. Prostate cancer (Gleason score ≥6) was detected in 46 cases (23.1%). Of these, 26 (56.5%) were detected by HoLEP pathology, 11 (23.9%) by TPNB pathology, and 9 (19.6%) by both. Univariate and multivariate logistic regression analyses were performed in 179 patients, including benign prostatic hyperplasia patients (N=153, 76.9%) and patients with cancer detected by HoLEP pathology. PSA density was identified as an independent predictor of prostate cancer detected by HoLEP in gray-zone PSA. CONCLUSIONS HoLEP is a viable modality for detecting prostate cancer in selected cases. PSA density was an independent predictor of prostate cancer detected by HoLEP in gray-zone PSA.
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Affiliation(s)
- Ki H Kim
- Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Chungcheongnam-do, South Korea
| | - Sang W Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Hee S Son
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Dae K Kim
- Department of Urology, CHA Gangnam Medical Center, CHA University, Seoul, South Korea
| | - Dae C Jung
- Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun W Kim
- Department of Urology, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Joon C Kim
- Department of Urology, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, South Korea
| | - Sung J Hong
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jang H Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea -
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Serafin A, Böhm L, Fernandez P, Achel D, Akudugu J. The potential of PAI-1 expression in needle biopsies as a predictive marker for prostate cancer. COGENT MEDICINE 2016. [DOI: 10.1080/2331205x.2016.1183275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Antonio Serafin
- Division of Radiobiology, Faculty of Medicine and Health Sciences, Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Tygerberg 7505, South Africa
| | - Lothar Böhm
- Division of Radiobiology, Faculty of Medicine and Health Sciences, Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Tygerberg 7505, South Africa
| | - Pedro Fernandez
- Faculty of Medicine and Health Sciences, Department of Urology, University of Stellenbosch, Tygerberg, South Africa
| | - Daniel Achel
- Division of Radiobiology, Faculty of Medicine and Health Sciences, Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Tygerberg 7505, South Africa
- Applied Radiation Biology Centre, Radiological and Medical Sciences Research Institute, Ghana Atomic Energy Commission, Accra, Ghana
| | - John Akudugu
- Division of Radiobiology, Faculty of Medicine and Health Sciences, Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Tygerberg 7505, South Africa
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Cho HJ, Shin SC, Cho JM, Kang JY, Yoo TK. The role of transurethral resection of the prostate for patients with an elevated prostate-specific antigen. Prostate Int 2014; 2:196-202. [PMID: 25599076 PMCID: PMC4286732 DOI: 10.12954/pi.14060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 10/01/2014] [Indexed: 12/20/2022] Open
Abstract
Purpose The aim of this study was to define the clinical significance of transurethral resection of the prostate (TURP) in patients with benign prostate hyperplasia (BPH) and an elevated prostate-specific antigen (PSA) level. Methods We retrospectively evaluated patients with BPH, lower urinary tract symptoms (LUTS; International Prostate Symptom Score [IPSS]≥8), an elevated serum PSA level (≥4 ng/mL), and previous negative transrectal ultrasonography (TRUS) guided prostate biopsy. The PSA level after TURP was monitored by long-term follow-up. The tumor detection rate on resected prostate tissue, IPSS, maximal urinary flow rate (Qmax), and postvoid residual urine (PVR) were analyzed. Results One-hundred and eighty-six patients were enrolled. Histological examination of resected tissue by TURP revealed prostate cancer in 12 of these patients (6.5%). Among 174 patients without prostate cancer, the mean PSA level and the PSA normalization rate in 112 patients followed up at postoperative day (POD) 3 months were 1.26±0.13 ng/mL and 94.6%, respectively. The mean PSA level and the PSA normalization rate were 1.28±1.01 ng/mL and 95.7% in 47 patients at 1st year, 1.17±0.82 ng/mL and 97.1% in 34 patients at second years, and 1.34±1.44 ng/mL and 97.2% in 36 patients at third years of TURP. One patient showed a dramatic increase in the PSA level was diagnosed with prostate cancer at 7 years after TURP. IPSS, quality of life, Qmax, and PVR were improved significantly at POD 3 months compared to baseline (P<0.05), respectively. Conclusions TURP significantly reduced the serum PSA level, which was maintained for at least 3 years. This could be helpful to screen the prostate cancer using PSA value in the patient with previous negative biopsy and elevated PSA. In addition, TURP improves IPSS, Qmax, and PVR in patients with BPH, moderate LUTS, and an elevated PSA level.
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Affiliation(s)
- Hee Ju Cho
- Department of Urology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Soon Cheol Shin
- Department of Urology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Jeong Man Cho
- Department of Urology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Jung Yoon Kang
- Department of Urology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Tag Keun Yoo
- Department of Urology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
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Kim M, Song SH, Ku JH, Oh SJ, Paick JS. Prostate cancer detected after Holmium laser enucleation of prostate (HoLEP): significance of transrectal ultrasonography. Int Urol Nephrol 2014; 46:2079-2085. [PMID: 24980863 DOI: 10.1007/s11255-014-0777-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 06/18/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE To identify predictors of incidental prostate cancer following Holmium laser enucleation of the prostate (HoLEP). METHODS We retrospectively analyzed 458 consecutive patients who underwent HoLEP. Patients were classified into two groups: patients who received prostate biopsy prior to HoLEP (biopsy group, n = 174) and patients who did not (non-biopsy group, n = 284). The two groups were compared. Logistic regression analysis was performed to determine the predictive factors. RESULTS A total of 27 patients (5.9 %) were incidentally diagnosed with prostate cancer. The incidence of prostate cancer was not significantly different between the two groups (biopsy group vs. non-biopsy group: 6.9 vs. 5.3 %, p = 0.48). Using multivariate analysis, a hypoechoic lesion identified by transrectal ultrasonography (TRUS) was the only predictor of incidental prostate cancer (odds ratio 2.829; 95 % confidence interval 1.061-7.539; p = 0.038). In the biopsy group, there were no significant differences in baseline characteristics including prostate size, prostate-specific antigen (PSA), PSA density, digital rectal examination (DRE) findings, and TRUS findings, between patients with and without prostate cancer. However, in the non-biopsy group, a hypoechoic lesion was found more frequently in patients with prostate cancer (prostate cancer vs. benign prostatic hyperplasia: 20.0 vs. 3.3 %, p = 0.02). CONCLUSIONS Prior negative prostate biopsy does not rule out the possibility of prostate cancer after HoLEP. The presence of a hypoechoic lesion on TRUS might be helpful to predict incidental prostate cancer after HoLEP in patients with normal PSA and negative DRE. Prostate biopsy prior to HoLEP should be considered in these patients.
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Affiliation(s)
- Myong Kim
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea
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Kang HW, Yang JB, Kwon WA, Lee YS, Kim WT, Kim YJ, Yun SJ, Lee SC, Kim IY, Kim WJ. Diagnostic role of prostate resection in the elderly patients who experience significant co-morbidity with a high clinical suspicion of prostate cancer. J Korean Med Sci 2013; 28:1796-800. [PMID: 24339711 PMCID: PMC3857377 DOI: 10.3346/jkms.2013.28.12.1796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 10/08/2013] [Indexed: 11/20/2022] Open
Abstract
The necessity of routine prostate biopsy prior to transurethral resection of the prostate (TURP) in elderly comorbid patients with a high prostate specific antigen (PSA) level remains controversial. We assessed the role of TURP in prostate cancer diagnosis in these individuals. A total of 197 patients underwent TURP in conjunction with prostatic needle biopsy. Pathologic reviews of specimens of TUR chips and biopsy cores were analyzed. Overall, prostate cancer (CaP) was detected in 114 patients (57.6%). Ninety-eight cancers (86%) were detected with TURP and biopsy, and seven cancers (6.1%) with only TURP. The Gleason score of a TUR-specimen was identical to that of the biopsy-core in 43.9% of cases. Variables associated with diagnostic accuracy in the TUR-specimens included the prebiopsy PSA level, prostate specific antigen density (PSAD), and the Gleason score in biopsy cores. In patients with a PSA level and a PSAD that was greater than 15.4 ng/mL and 0.69 ng/mL/g, respectively, 100% of the cancers were detected in the TUR-specimens. Our results suggest that a prostatic biopsy might be omitted prior to TURP in elderly patients with significant co-morbidity and levels for PSA of >15.4 ng/mL.
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Affiliation(s)
- Ho Won Kang
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Jin Bak Yang
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Whi-An Kwon
- Department of Urology, Wonkwang University, Sanbon Hospital, Gunpo, Korea
| | - Young-Suk Lee
- Department of Urology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Won Tae Kim
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Yong-June Kim
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Seok-Joong Yun
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Sang-Cheol Lee
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Isaac Yi Kim
- Section of Urologic Oncology, Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Wun-Jae Kim
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
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Abstract
Grayscale transrectal ultrasonographic prostate biopsy using local anesthesia remains the standard approach to the definitive diagnosis of prostate cancer. Careful patient evaluation and preparation are essential to maximize the results and minimize the complications of the biopsy procedure.
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Affiliation(s)
- Mohamed T Ismail
- Department of Urology, VA Medical Center, 1601 Kirkwood Highway, Wilmington, DE 19805, USA; Department of Urology, Thomas Jefferson University, 1025 Walnut Street, 1102, Philadelphia, PA 19107, USA
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Yates DR, Gregory GC, Roupret M, Malki MM, Haynes MD, Hamdy FC, Rosario DJ. Transurethral resection biopsy as part of a saturation biopsy protocol: a cohort study and review of the literature. Urol Oncol 2013; 31:542-8. [PMID: 21493112 DOI: 10.1016/j.urolonc.2011.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 02/09/2011] [Accepted: 02/13/2011] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the prostate cancer (CaP) detection rate and morbidity of performing a transurethral resection biopsy of the prostate (TURBP) at the same time as a saturation biopsy (SBx). PATIENTS A total of 102 men with previous negative transrectal ultrasound (TRUS) biopsies underwent a SBx under formal anaesthesia. Fifty-four [54 (52.9%)] had a combined SBx and TURBP (Group 1) and 48 (47.1%) had a SBx only (Group 2). RESULTS The CaP detection rate in Group 1 was 38.9% (21/54), which was significantly higher than the detection rate of 27.1% (13/48) in Group 2 (P = 0.005). CaP was detected via TURBP in 12 patients (22.2%) from Group 1, including 8 (14.8%) patients who had CaP solely in their TURBP chips. According to the D'Amico classification, 66.6% (14/21) of the cancers in Group 1 were intermediate (n = 4) or high risk (n = 10). Of the 8 'TURBP only' cancers, 75% (6/8) were intermediate (n = 2) or high risk (n = 4). Seven of these eight patients went on to have a radical prostatectomy (RP) but only 2 (28.6%) were found to have a pure anterior/transition zone (TZ) tumor. The postoperative urinary retention and emergency admission rates for Groups 1 and 2 were 29.6% (16/54) vs. 16.6% (8/48) (P = 0.095) and 11.1% (6/54) vs. 5.5% (2/48) (n = 0.17). There was no difference in terms of hematuria (P = 0.54), urinary tract infection (UTI) (P = 0.22), or sepsis (P = 0.21), and patients in Group 1 spent an average of 0.5 days longer in hospital (1.9 vs. 1.4; P = 0.008). CONCLUSIONS TURBP in association with SBx increases the detection of clinically important CaP. However, this does have to be balanced against the small increased incidence of urinary retention, emergency re-admission, and longer hospital stay.
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Affiliation(s)
- David R Yates
- Department of Urology, Royal Hallamshire Hospital, Sheffield, South Yorkshire, United Kingdom.
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Lunacek A, Simon J, Bernt R, Huber M, Plas E, Mrstik C. Increased rate of positive biopsies using a combination of MR-Tomography, spectroscopy and diffusion-weighted magnetic resonance imaging prior to prostate biopsies in patients with persistent elevated prostate-specific antigen values: A retrospective analysis. Urol Ann 2013; 5:76-80. [PMID: 23798861 PMCID: PMC3685749 DOI: 10.4103/0974-7796.110001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Accepted: 03/03/2012] [Indexed: 02/07/2023] Open
Abstract
Purpose: Persistently elevated prostate-specific antigen (PSA) values following negative biopsies result in a diagnostic dilemma. In order to improve detection rates in patients with former negative biopsies and persistently elevated PSA values, magnetic resonance tomography (MRT), magnetic resonance spectroscopy (MRS), and diffusion-weighted magnetic resonance imaging (DW-MRI) were performed prior to prostate rebiopsies. Materials and Methods: Over a 14-month period, 67 patients (mean age of 66 years) with a history of 1-5 negative biopsies underwent endorectal magnetic resonance imaging (MRI) using T2-weighted MRT MRS and DW-MRI before an additional prostate biopsy was performed. Subsequently, 5 contrast-enhanced transrectal ultrasound-guided biopsies were performed according to a 10-core systematic scheme. Out of the 67 men, 25 patients had positive biopsies and opted for radical prostatectomy. Histological evaluation of cancer localization, PSA, diameters of primary tumors, numbers and diameters of satellite tumors, prostate volume, and staging pathology was performed. These findings were compared with MRI and MRS results. Results: Serum PSA levels ranged from 3.1 to 19.5 g/ml (median level of 7.96 ng/ml). After the 25 patients underwent radical prostatectomy, analysis of 20 whole-mount sections of 25 radical retropubic prostatectomy (RPE) specimens presented results agreeing with the tumor location from MRI and MRS data. Conclusions: The aim of image-guided diagnostics should be to provide more critical information prior to biopsy. Furthermore, the acquisition of such data is important for better risk stratification in therapeutic decisions.
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Affiliation(s)
- A Lunacek
- Department of Urology, Hanusch Krankenhaus, Vienna, Austria
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12
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Is sampling transitional zone in patients who had prior negative prostate biopsy necessary? Int Urol Nephrol 2012; 44:1071-5. [PMID: 22418763 DOI: 10.1007/s11255-012-0139-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Accepted: 02/02/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess the necessity of transitional zone sampling of the prostate during repeat prostate biopsy procedures. METHODS Patients treated for lower urinary tract symptoms with transurethral resection of the prostate (TURP) from April 2004 to July 2009 whom had at least 1 negative prostate biopsy prior to this treatment were chosen as the study group. A histopathological analysis of surgical specimens was employed to determine cancer detection rates. RESULTS A total of 72 patients with the mean age of 66.1, mean prostate-specific antigen (PSA) of 10.4 ng/mL and mean prostate volume of 63.2 cc were included. Of the patients, 50 had 1 biopsy set, 17 had 2 sets, 4 had 3 sets and 1 patient had 4 sets of consecutive biopsies. All biopsy results were negative for prostate cancer. After the analysis of surgical specimens obtained during TURP, cancer was detected in 3 patients (4.2%). Transitional zone sampling during prostate biopsies did not significantly improve the cancer detection rate. Transitional zone sampling was performed in 29 biopsies taken from 20 patients, one of whom (5%) had prostate cancer. The remaining 71 biopsies were taken from 52 patients without transitional zone sampling, and cancer was detected in 2 (3.8%) of them. CONCLUSIONS Since no significant difference was observed between patient groups (those with and those without transitional zone biopsies) in the detection of prostate cancer in the transitional zone, strategies for increasing the number of cores taken from transitional zone during repeat biopsies should be reconsidered.
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Chen SS, Chiu LP, Chen KK. Comparison of transrectal ultrasound-guided biopsy of the prostate and transurethral resection of the prostate for detection of prostate cancer in patients with moderate lower urinary tract symptoms. J Chin Med Assoc 2010; 73:568-72. [PMID: 21093824 DOI: 10.1016/s1726-4901(10)70125-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 07/09/2010] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To compare transrectal ultrasound (TRUS)-guided biopsy of the prostate and transurethral resection of the prostate (TURP) for detection of prostate cancer (PCa) in patients with moderate lower urinary tract symptoms (LUTS) by retrospective chart review. METHODS Between January 2004 and December 2008, a total of 520 patients, aged 50.3-81.5 years, with moderate LUTS (International Prostate Symptom Score, 8-19), and elevation of prostate-specific antigen (≥ 4 ng/mL), or abnormal findings by digital rectal examination, were enrolled for evaluation. All the patients were recommended to receive TRUS-guided biopsy of the prostate (TRUS biopsy group) or TURP (TURP group) due to the possibility of PCa, according to their choice after full explanation by the doctors. RESULTS There were 379 patients in the TRUS biopsy group and 141 in the TURP group. PCa was detected in 80 patients (21.1%) in the TRUS group and in 27 (19.1%) in the TURP group. Clinically localized PCa (T1-2N0M0) was found in 46 patients (57.5%) in the TRUS biopsy group and in 16 (59.3%) in the TURP group. Bone metastasis was noticed in 22 (27.5%) patients in the TRUS biopsy group and in 7 (25.9%) in the TURP group. The percentage of low-grade tumor was significantly higher in the TURP group than in the TRUS biopsy group (11.1% vs. 5%). CONCLUSION TURP was not superior to TRUS-guided biopsy of the prostate for detection of PCa in patients with moderate LUTS and prostate-specific antigen ≥ 4 ng/mL.
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Affiliation(s)
- Shiou-Sheng Chen
- Division of Urology, Taipei City Hospital Renai Branch, Taipei, Taiwan, ROC
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Kim DK, Kim SJ, Moon HS, Park SY, Kim YT, Choi HY, Lee TY, Park HY. The Role of TURP in the Detection of Prostate Cancer in BPH Patients with Previously Negative Prostate Biopsy. Korean J Urol 2010; 51:313-7. [PMID: 20495693 PMCID: PMC2873884 DOI: 10.4111/kju.2010.51.5.313] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 04/22/2010] [Indexed: 12/26/2022] Open
Abstract
PURPOSE We aimed to investigate the significance of early detection of transition zone prostate cancer by transurethral resection of prostate (TURP) in benign prostatic hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS) in whom prostate cancer was suspected despite a negative transrectal ultrasonography (TRUS) biopsy result. MATERIALS AND METHODS From January 2006 to January 2009, a total of 165 patients who underwent TURP were evaluated. The prostate cancer detection rate was compared between patients who underwent TRUS biopsy before TURP (group A) and those who did not (group B). All charts were evaluated retrospectively, including prostate-specific antigen (PSA), digital rectal examination (DRE), TURP results (including resection volume and pathology report), TRUS, and TRUS biopsy results. Group A was subdivided into group A1, who were diagnosed with prostate cancer after TURP, and group A2, who were diagnosed with BPH after TURP. RESULTS The cancer detection rate showed no significant difference between groups A and B (8.9% vs. 7.5%, p>0.05). The mean PSA levels in groups A1 and A2 were 15.5+/-14.0 ng/ml and 9.1+/-5.1 ng/ml, respectively (p>0.05). In group A1, 40% had an abnormal DRE, compared with 6.7% in group A2 (p<0.05). After TURP, the mean percentage of resected prostatic chips of the prostate cancer group and BPH group were 33.9% and 18.6%, respectively (p=0.001). A positive correlation was found between the detection rate of prostate cancer and PSA (p=0.01). CONCLUSIONS BPH patients in whom prostate cancer is suspected and who have lower urinary tract symptoms (LUTS) with a previously negative TRUS biopsy result can undergo TURP, which results in immediate improvement in bladder outlet obstruction and early diagnosis of clinically significant transition zone prostate cancer.
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Affiliation(s)
- Dae Keun Kim
- Department of Urology, College of Medicine, Hanyang University, Seoul, Korea
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Cho JM, Lee SW, Kang JY, Yoo TK. Safety and efficacy of combined transrectal ultrasound-guided prostate needle biopsy and transurethral resection of the prostate. Korean J Urol 2010; 51:101-5. [PMID: 20414421 PMCID: PMC2855484 DOI: 10.4111/kju.2010.51.2.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 01/04/2010] [Indexed: 12/31/2022] Open
Abstract
Purpose This study was conducted to examine whether simultaneous transrectal prostate needle biopsy (TPNB) owing to an increase in prostate-specific antigen (PSA) levels is safe and effective in patients who are scheduled for transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH). Materials and Methods Combined TPNB and TURP was performed in a total of 42 patients aged 60 years and older who had gray-zone PSA values (4-10 ng/ml) and PSA density (PSAD) values of 0.12 and less. The frequencies of fever, sepsis, and epididymitis were assessed after surgery. The diagnostic accuracy was assessed, and the results of histologic examination were evaluated in terms of TPNB or TURP. In addition, the diagnostic accuracy was assessed according to age. Results Prostate cancer was diagnosed in 6 (14.3%) of the 42 patients: 2 patients were diagnosed with prostate cancer by TPNB only, 3 patients by TURP only, and 1 patient by combined TPNB and TURP. Four (25%) of the 16 patients aged under 70 years and 2 (7.8%) of the 26 patients aged 70 years and older were diagnosed with prostate cancer. Fever was observed in 9 patients (21.4%), 4 (9.5%) of whom had a fever of higher than 38℃. The fever normalized the day after surgery in all 9 patients. No septicemia was noted. There were no serious complications related to combined TPNB and TURP. Conclusions The results of this study suggest that combined TPNB and TURP may be safe and effective in patients who require TURP.
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Affiliation(s)
- Jeong Man Cho
- Department of Urology, Eulji University School of Medicine, Seoul, Korea
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Pepe P, Fraggetta F, Galia A, Grasso G, Aragona F. Prostate cancer detection by TURP after repeated negative saturation biopsy in patients with persistent suspicion of cancer: a case–control study on 75 consecutive patients. Prostate Cancer Prostatic Dis 2009; 13:83-6. [DOI: 10.1038/pcan.2009.46] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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17
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Ploussard G, Dubosq F, Boublil V, Allory Y, de la Taille A, Vordos D, Hoznek A, Abbou CC, Salomon L. Extensive biopsies and transurethral prostate resection in men with previous negative biopsies and high or increasing prostate specific antigen. J Urol 2009; 182:1342-9. [PMID: 19683310 DOI: 10.1016/j.juro.2009.06.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Indexed: 12/15/2022]
Abstract
PURPOSE We determined the diagnostic role of an extensive biopsy protocol associated with transurethral prostate resection in patients with persistently increased or increasing prostate specific antigen without evidence of prostate cancer after 2 or more extended negative sets of biopsies. MATERIALS AND METHODS A new set of 21-core biopsies was done in 113 patients under general anesthesia in association with transurethral prostate resection. Demographics, clinical and biological data, operative parameters, pathological results and followup were recorded prospectively. RESULTS Extended biopsies provided an 18.6% detection rate and detected 77.8% of prostate cancers. Transurethral prostate resection significantly increased the detection rate by 28.5% for an overall 23.9% prostate cancer detection rate (p = 0.035). Most prostate cancer detected on chips and/or biopsy was clinically significant and 30% were scored as Gleason 7 or greater. Of prostatectomy specimens 19% showed pT3a-pT4 cancer with a median Gleason score of 7. In patients with no cancer mean prostate specific antigen 1 year after transurethral prostate resection was 4.5 ng/ml (range 0.3 to 16.3), which remained stable during followup. A third of these patients underwent repeat biopsy with a 16.7% prostate cancer detection rate. CONCLUSIONS About a fourth of patients with at least 2 extended negative sets of prostate biopsies remain at risk for prostate cancer and most tumors missed on initial procedures are clinically significant. Repeat biopsy using general anesthesia detects three-fourths of these prostate cancers. However, the diagnostic yield of transurethral prostate resection appears significant and may provide additional data of clinical importance in select, informed patients.
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Affiliation(s)
- Guillaume Ploussard
- Institut National en Santé et Recherche Médicale U955 EQ7, Department of Urology, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Henri Mondor, Créteil, France
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A review of repeat prostate biopsies and the influence of technique on cancer detection: our experience. Ir J Med Sci 2009; 178:287-90. [PMID: 19495832 DOI: 10.1007/s11845-009-0362-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Accepted: 05/02/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND Follow-up of patients with an initial negative prostate biopsy, but surrounding whom a suspicion of prostate cancer persists, is difficult. In addition, debate exists as to the optimal technique for repeat prostate biopsy. AIMS To assess the cancer detection rate on repeat prostate biopsy. METHODS We reviewed patients who underwent prostate biopsy in our department in 2005 who had >or=1 previous biopsy within the preceding 5 years. Cancer detection rate on repeat biopsy and the influence of the number of biopsy cores were recorded. RESULTS Cancer detection rate on repeat biopsy was 15.4%, with approximately 60% detected on the first repeat biopsy, but approximately 10% not confirmed until the fourth repeat biopsy. Gleason score was similar regardless of the time of diagnosis (6.1-6.5). Mean interval between first biopsy and cancer diagnosis (range 18-55 months) depended on the number of repeat procedures. There was an association between the number of biopsy cores and cancer detection. CONCLUSIONS This study supports the practice of increasing the number of cores taken on initial and first repeat biopsy to maximise prostate cancer detection and reduce the overall number of biopsies needed.
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van Renterghem K, Van Koeveringe G, Achten R, van Kerrebroeck P. A new algorithm in patients with elevated and/or rising prostate-specific antigen level, minor lower urinary tract symptoms, and negative multisite prostate biopsies. Int Urol Nephrol 2009; 42:29-38. [PMID: 19496018 PMCID: PMC2844972 DOI: 10.1007/s11255-009-9596-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 05/17/2009] [Indexed: 01/21/2023]
Abstract
Patients with elevated and/or rising prostate-specific antigen (PSA), minor lower urinary tract symptoms (LUTS), and no evidence for prostate cancer on (multiple) extended prostate biopsies are a regularly encountered problem in urological practice. Even now, patients are seen with no objective explanation of this persistent elevated and/or rising PSA. So far, many strategic proposals have been elaborated and published to deal with this specific population including the use of different PSA derivates; applying different biopsy schemes—strategies—biopsy target imaging; diagnostic use of prostate cancer genes; and many more. In this review, we propose a new algorithm in which an urodynamic evaluation should be included since bladder outlet obstruction (BOO) can be expected. Once BOO is confirmed, a transurethral resection of the prostate (TURP) can be offered to these patients. This procedure will result in subjective and biochemical improvement and allows extensive histological examination. Current literature was reviewed with regard to this specific population. This research was performed using the commercially available Medline online search tools and applying the following search terms: “diagnostic TURP”; “elevated PSA”; and “prostate biopsy”. Furthermore, subsequent reference search was executed on retrieved articles.
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van Renterghem K, Van Koeveringe G, Achten R, van Kerrebroeck P. Prospective study of the role of transurethral resection of the prostate in patients with an elevated prostate-specific antigen level, minor lower urinary tract symptoms, and proven bladder outlet obstruction. Eur Urol 2008; 54:1385-92. [PMID: 18599187 DOI: 10.1016/j.eururo.2008.06.069] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 06/16/2008] [Indexed: 12/15/2022]
Abstract
BACKGROUND Deciding on strategy for patients with minor lower urinary tract symptoms (LUTS), elevated prostate-specific antigen (PSA) levels, unsuspicious digital rectal examination (DRE) and/or transrectal ultrasound (TRUS), and multiple negative extended prostate biopsies is complex. OBJECTIVES To define the role and clinical significance of transurethral resection of the prostate (TURP) in these patients. DESIGN, SETTINGS, AND PARTICIPANTS Thirty-three patients with elevated PSA; minor LUTS, as assessed by the International Prostate Symptoms Score (IPSS); no suspicion for prostate cancer on DRE and/or TRUS; and negative extended prostate biopsies were prospectively enrolled in a cohort study at a tertiary care institution. INTERVENTION After full urodynamic investigation showing all patients to be bladder outlet obstructed, TURP was performed. MEASUREMENTS Resected tissue was histologically examined for presence of prostate cancer. Within 6 mo after TURP, patients were clinically reevaluated by means of IPSS and PSA level. RESULTS AND LIMITATIONS Preoperatively, mean PSA and IPSS values were 8.2ng/ml and 6.8, respectively. Mean detrusor pressure at maximum flow was 80.3cm H(2)O. Histological examination after TURP revealed benign prostate hyperplasia in 81.8% (subgroup 1) and aggressive prostate cancer in 6.1% of patients (subgroup 2). In 12.1% of patients, only a few chips of nonaggressive prostate cancer (T1a) were detected. In patients without signs of aggressive prostate cancer (93.9%=12.1%+81.8%, subgroup 3), mean postoperative PSA and IPSS values were 0.6ng/ml and 2.4, respectively, while these values were 0.6ng/ml and 2.5ng/ml in subgroup 1 (p<0.0001). This study is limited in sample size, requiring more research to confirm these results. CONCLUSIONS This prospective study shows that, in patients with minor LUTS and no suspicion for prostate cancer, bladder outlet obstruction can result in elevated PSA levels. These patients will benefit from TURP regarding symptomatology and supernormalisation of PSA levels. Moreover, albeit in few cases, histological examination will reveal aggressive prostate cancer.
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Descazeaud A, Peyromaure M, Salin A, Amsellem-Ouazana D, Flam T, Viellefond A, Debré B, Zerbib M. Predictive Factors for Progression in Patients with Clinical Stage T1a Prostate Cancer in the PSA Era. Eur Urol 2008; 53:355-61. [PMID: 17611015 DOI: 10.1016/j.eururo.2007.06.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 06/13/2007] [Indexed: 12/20/2022]
Abstract
OBJECTIVE In the literature, most data regarding the outcome of patients with clinical stage T1a prostate cancer were established before the prostate-specific antigen (PSA) era. The aim of our study was to determine the predictive factors of progression in patients with T1a prostate cancer diagnosed in the PSA era. METHODS Consecutive patients (n=144) with newly diagnosed T1a prostate cancer (tumor involving < or =5% of the resected prostatic tissue) were included. None of them was treated before evidence of tumor progression confirmed by prostate needle biopsies. The associations between tumor characteristics and time to cancer progression were assessed using Cox regression analysis. RESULTS With a mean follow-up of 5.1 yr, 30 patients (21%) experienced cancer progression. Five adverse parameters were significantly associated with cancer progression: preoperative PSA> or =10 ng/ml, postoperative PSA> or =2 ng/ml, prostate weight > or =60 g, weight of resected tissue > or =40 g, and Gleason score> or =6. The 5-yr progression rate was 12% if fewer than two of these parameters were present, whereas it was 47% if two or more parameters were present (p<0.001). CONCLUSION In the PSA era the risk of progression associated with T1a prostate cancer can be predicted using five criteria, and two groups of patients can be defined. The patients at low risk of progression may be good candidates for surveillance. In those with a high risk of progression, a more aggressive treatment should be discussed.
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Ramírez Backhaus M, Trassierra Villa M, Bahilo Mateu P, Pontones Moreno J, Santamaría Navarro C, Ruiz-Cerdá J, Vera Donoso C, Jiménez Cruz J. Desarrollo de un Modelo Matemático preliminar para la detección de cáncer de próstata en los pacientes con biopsias prostáticas de repetición. Actas Urol Esp 2008; 32:281-7. [DOI: 10.1016/s0210-4806(08)73832-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Importancia de la velocidad y la densidad de PSA en la predicción de cáncer de próstata en la pieza de RTU o adenomectomía de pacientes con biopsia prostática previa negativa. Actas Urol Esp 2008. [DOI: 10.1016/s0210-4806(08)73935-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Puppo P. Repeated negative prostate biopsies with persistently elevated or rising PSA: a modern urologic dilemma. Eur Urol 2007; 52:639-41. [PMID: 17451871 DOI: 10.1016/j.eururo.2007.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Accepted: 04/03/2007] [Indexed: 12/19/2022]
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van Renterghem K, Van Koeveringe G, Achten R, Van Kerrebroeck P. Clinical relevance of transurethral resection of the prostate in "asymptomatic" patients with an elevated prostate-specific antigen level. Eur Urol 2007; 52:819-26. [PMID: 17418482 DOI: 10.1016/j.eururo.2007.03.055] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Accepted: 03/16/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the clinical relevance of transurethral resection of the prostate (TURP) in patients with minor lower urinary tract symptoms (LUTS) but elevated prostate-specific antigen (PSA) levels. METHODS We retrospectively included 82 patients, aged 50.2-78.2 yr, with minor LUTS, elevated PSA (> or =4 ng/ml), and no signs of prostate cancer (PCa) after (multiple) negative multisite biopsies who underwent TURP after they were diagnosed by urodynamics with bladder outlet obstruction (BOO). We evaluated the clinical benefit of TURP by assessing its effect on International Prostate Symptom Score (IPSS) and PSA and the diagnostic value of histologic examination of the resected tissue for the presence of PCa. RESULTS After TURP, histologic analysis of the resected specimen revealed that eight patients (9.8%) had PCa; seven of these patients had a tumour that needed further treatment. The remaining 74 patients (90.2%) were diagnosed with BOO due to benign prostatic hyperplasia/benign prostatic enlargement (BPH/BPE). In this group, the mean PSA level decreased from 8.8 ng/ml before TURP to 1.1 ng/ml in the first year and 1.3 ng/ml in the second year after TURP; the mean IPSS decreased from 8.8 to 1.5 in the first year after TURP. CONCLUSIONS The current data suggest that patients with minor LUTS and elevated PSA without evidence of PCa are very likely to have BOO due to BPH/BPE and may benefit from TURP if obstruction is proved. However, a prospective trial is warranted to assess the impact of these results on clinical practice.
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Cho KJ, Ha US, Lee CB. Role of Transurethral Resection of the Prostate in the Diagnosis of Prostate Cancer for Patients with Lower Urinary Tract Symptoms and Serum PSA 4-10ng/ml with a Negative Repeat Transrectal Needle Biopsy of Prostate. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.10.1010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Kang Jun Cho
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - U-Syn Ha
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Choong Bum Lee
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
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Moon K, Theodorescu D. Does saturation biopsy improve prostate cancer detection? NATURE CLINICAL PRACTICE. UROLOGY 2006; 3:468-9. [PMID: 16964184 DOI: 10.1038/ncpuro0552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Accepted: 05/30/2006] [Indexed: 12/28/2022]
Affiliation(s)
- Kihyuck Moon
- Urologic Oncology, University of Virginia, Charlottesville, VA, USA
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28
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Bratt O. The difficult case in prostate cancer diagnosis--when is a "diagnostic TURP" indicated? Eur Urol 2006; 49:769-71. [PMID: 16457943 DOI: 10.1016/j.eururo.2006.01.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Indexed: 12/14/2022]
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