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Incidence of Prostatic Adenocarcinoma in Transurethral Resection Of the Prostate (TURP) Specimens in the PSA Screening Era
Saman S. Talab, MD1, Steven Lee Chang, MD, MS2, Chin-Lee Wu, MD, PhD1, Shahin Tabatabaei, MD1.
1Massachusetts General Hospital, Boston, MA, USA, 2Brigham and Women's Hospital, Boston, MA, USA.
BACKGROUND: The incidental detection of prostate cancer in patients who undergo TURP for benign prostatic hyperplasia (BPH) is reported to be as high as 15%. Most of the published data however, have been done in pre-PSA screening era. In this study, we aimed to evaluate the incidence of prostate adenocarcinoma in TURP specimens of patients with initial diagnosis of BPH.
METHODS: We retrospectively reviewed clinical and pathologic records of all consecutive patients who underwent TURP with initial diagnosis of BPH, from January 2000 to June 2012. All patients were evaluated preoperatively with digital rectal examination and PSA screening. Those with previous history of prostate cancer were excluded from analysis. The data regarding patients’ age, race, pre-op PSA level and amount of resected tissue during TURP was also evaluated.
RESULTS: Overall 1270 patients met our inclusion criteria. The mean age of patients was 71.1 y/o ranging from 31 to 94 y/o. 1208 patients (95.1%) demonstrated benign pathology with no evidence of carcinoma; these included BPH or inflammation. Pathology report in 62 patients (4.9%) showed malignant lesions; out of this, 54 patients (87.1%) had Gleason score 6 and lower. The probability of prostate cancer incidence in TURP chips shows a decrescendo pattern over the time. There was no significant difference between preoperative PSA levels in patients with benign and malignant lesions (4.4±4.8 and 4.7±6.7 ng/ml, p-value=0.67). Furthermore, There was also no significant correlation between patient’s age, race, and amount of resected tissue and incidence of prostate cancer.
CONCLUSIONS: In the PSA screening era, the incidental finding of prostate cancer in TURP specimens is substantially lower than what was noted in the pre-PSA screening era. Furthermore, the large majority of prostate cancer that found in our study cohort considered low risk in the majority of cases and most likely would not have affected the patients’ longevity, if it had been missed. Provided that these results are validated in other studies, the risk of missing a clinically significant prostate cancer in patients who undergo laser vaporization of prostate is negligible.
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