J Korean Med Sci.  2013 Dec;28(12):1796-1800. 10.3346/jkms.2013.28.12.1796.

Diagnostic Role of Prostate Resection in the Elderly Patients Who Experience Significant Co-Morbidity with a High Clinical Suspicion of Prostate Cancer

• Kang HW
• Yang JB
• Kwon WA
• Lee YS
• Kim WT
• Kim YJ
• Yun SJ
• Lee SC
• Kim IY
• Kim WJ

• KMID: 1779422
• DOI: http://doi.org/10.3346/jkms.2013.28.12.1796

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.

Keyword

Prostate Neoplasms; Transurethral Prostatic Resection of Prostate; Transrectal Prostate Biopsy; Prostate-Specific Antigen

MeSH Terms

Aged
Aged, 80 and over
Area Under Curve
Biopsy, Needle
Comorbidity
Humans
Male
Neoplasm Grading
Prostate/*surgery
Prostate-Specific Antigen/*blood
Prostatic Neoplasms/*diagnosis/epidemiology/*pathology/surgery
ROC Curve
Transurethral Resection of Prostate
Prostate-Specific Antigen

Figure

• 

  Fig. 1 Receiver operating characteristic (ROC) curve generated for calculated the cancer detection in TUR specimen in related to PSA and PSAD. AUC, area under the curve; PSA, Prostate specific antigen; PSAD, Prostate specific antigen density.

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