Is there a PSA cut-off value indicating incidental prostate cancer in patients undergoing surgery for benign prostatic hyperplasia?
Aim: To investigate incidental prostate cancer (IPCa) rate and to determine prostate specific antigen (PSA) cut-off value indicating PCa in patients who underwent surgery by being diagnosed with benign prostatic hyperplasia (BPH) clinically or by standard prostate biopsy.
Methods: Data of 317 patients, who underwent transurethral resection of the prostate (TURP) or open prostatectomy (OP) with pre-diagnosis of BPH, were evaluated retrospectively. The examined parameters included patients’ demographics, preoperative serum PSA values, digital rectal examination (DRE) findings, surgical method, histopathological findings and Gleason Scores.
Results: A total of 317 patients were included the study. The median age of patients was 69 years (min: 51-max: 79) and the median PSA value was 3.24 ng/dl (min: 0.17-max: 34.9). In 21 patients (6.6%); DRE findings were in favor of malignancy, but prostate biopsy resulted as BPH. While 281 (88.6%) of the patients underwent TURP, 36 (11.4%) underwent open prostatectomy. PCa was detected in 21 (6.6%) patients. PSA was statistically higher in patients who underwent OP compared to patient who underwent TUR-P, 5.9 (min: 1.2 - max: 27.6, IR: 8.7) vs. 2.8 (min: 0.1-max: 34.9, IR: 4.2) ng/dl, p < .001. The rate of IPCa among four PSA group was similar (p = 0.46). There was no difference between the rate of IPCa in patients younger and older than 70 years, (p = 0.11). Please change whole sentence as 'The median PSA level was slightly higher in patients diagnosed with BPH compared to patients diagnosed with IPCa, 3.2 (min: 0.1-max: 34.9) vs. 2.7 (min: 0.3-max: 26.5) ng/dL, p = 0.9.
Conclusions: IPCa still remains an important clinical problem. We were not able to find any correlation of PSA and age with incidental PCa.
Jemal A, Murray T, Ward E, et al.. Cancer statistics. CA Cancer J Clin. 2005; 55:10-30. DOI: https://doi.org/10.3322/canjclin.55.1.10
Stangelberger A, Waldert M, Djavan B. Prostate Cancer in Elderly Men.Rev Urol.2008; 10 : 111–119.
Yoo C, Oh CY, Kim SJ, et al.. Preoperative clinical factors for diagnosis of incidental prostate cancer in the era of tissue-ablative surgery for benign prostatic hyperplasia: a Korean multi-center review. Korean J Urol. 2012; 53:391–395. DOI: https://doi.org/10.4111/kju.2012.53.6.391
Abedi AR, Fallah-Karkan M, Allameh F, Ranjbar A, Shadmehr A. Incidental prostate cancer: a 10-year rewiew of a tertiary center, Tehran, Iran. Res Rep Urol. 2018. 9;10:1-6. DOI: https://doi.org/10.2147/RRU.S146159
Stamey TA, Kabalin JN, McNeal JE.. Prostate specific antigen in the diagnosis and treatment of adenocarcinoma of prostate. J Urol. 1989; 141: 1076. DOI: https://doi.org/10.1016/S0022-5347(17)41175-X
Voigt S, Hüttig F, Koch R, et al. Risk factors for incidental prostate cancer who should not undergo vaporization of the prostate for benign prostate hyperplasia? Prostate. 2011; 71:1325–1331. DOI: https://doi.org/10.1002/pros.21349
Helfand BT, Anderson CB, Fought A, Kim DY, Vyas A, McVary KT.Postoperative PSA and PSA velocity identify presence of prostate cancer after various surgical interventions for benign prostatic hyperplasia. Urology. 2009;74:177–183. DOI: https://doi.org/10.1016/j.urology.2008.10.062
Trpkov K, Thompson J, Kulaga A, Yilmaz A. How much tissue sampling is required when unsuspected minimal prostate carcinoma is identified on transurethral resection?Arch Pathol Lab Med. 2008;132:1313-6. DOI: https://doi.org/10.5858/2008-132-1313-HMTSIR
Jahn JL, Giovannucci EL, Stampfer MJ. The High Prevalence of Undiagnosed Prostate Cancer at Autopsy: Implications for Epidemiology and Treatment of Prostate Cancer in the Prostate-Specific Antigen-Era. Int J Cancer. 2015; 137: 2795-2802. DOI: https://doi.org/10.1002/ijc.29408
McConnell JD. Epidemiology, etiology, pathophysiology, and diagnosis of benign prostatic hyperplasia. In: Walsh PC, Retik AB, VaughanJr ED, Wein AJ, eds. Campbell’sUrology. 7thed. Philadelphia: WB Saunders Company. 1998p.1429-52.
Fernández RE, Gómez VF, Alvarez CL, Ruibal MM, Chantada AV, González MM.. Clinicopathological study of incidental cancer prostate in patients undergoing surgery for symptomatic diagnosis of BPH. Actas Urol Esp. 2006;30:33–37
Parkin DM, Bray F, Ferlay J, Pisani P. 2005. Global cancer statistics. CA Cancer J Clin. 2002;55:74-108. DOI: https://doi.org/10.3322/canjclin.55.2.74
Landis SH, Murray T, Bolden S, Wingo PA. Cancer statistics. CA Cancer J Clin. 1999;49:8-31. DOI: https://doi.org/10.3322/canjclin.49.1.8
Rohr LR. Incidental adenocarcinoma in transurethral resections of prostate. Am J SurgPathol. 1987; 11: 53-8. DOI: https://doi.org/10.1097/00000478-198701000-00007
Merril RM, Wiggins CL. Incidental detection of population based prostate cancer incidence rates trough transurethral resection of the prostate. Urol Oncol. 2002;7: 213-9. DOI: https://doi.org/10.1016/S1078-1439(02)00193-X
Zigeuner RE, Lipsky K, Rieder I et al. Didthe rate of incidental prostate cancer change in the era of PSA testing? A retrospective study of 1127 patients. Urology; 200362: 451-5. DOI: https://doi.org/10.1016/S0090-4295(03)00459-X
Zigeuner R, Schips L, Lipsky K, et al. Detection of prostate cancer by TURP or open surgery in patients with previously negative transrectal prostate biopsies. Urology 2003; 62: 883-887. DOI: https://doi.org/10.1016/S0090-4295(03)00663-0
Otto B, Barbieri C, Lee R et al. Incidental Prostate Cancer in Transurethral Resection of the Prostate Specimens in the Modern Era. Adv Urol. 2014: 627290 DOI: https://doi.org/10.1155/2014/627290
Borkowetz A, Platzek I, Toma M et al. Comparison of systematic transrectal biopsy to transperineal MRI/ultrasound-fusion biopsy for the diagnosis of prostate cancer. BJU Int. 2015;116: 873-9. DOI: https://doi.org/10.1111/bju.13023
Kasivisvanathan V, Rannikko AS, Borghi M et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med, 2018;378:1767-77. DOI: https://doi.org/10.1056/NEJMoa1801993
Kasivisvanathan V, Stabile A, Neves JB et al.. Magnetic Resonance Imaging-targeted Biopsy Versus Systematic Biopsy in the Detection of Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol. 2019;76:284-303. DOI: https://doi.org/10.1016/j.eururo.2019.04.043
- Abstract views: 139
- PDF: 101
Copyright (c) 2021 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.