Korean J Urol.  2007 Oct;48(10):1010-1015. 10.4111/kju.2007.48.10.1010.

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 Prostat

• Cho KJ
• Ha US
• Lee CB

• KMID: 2139731
• DOI: http://doi.org/10.4111/kju.2007.48.10.1010

Abstract

PURPOSE: Transrectal needle biopsy of the prostate is a definitive diagnostic procedure for prostate cancer. However, the sensitivity of a third biopsy is very low in patients with serum prostate-specific antigen(PSA) 4-10 ng/ml and negative repeat prostate biopsy. In addition, multiple prostate biopsies usually have low patient compliance due to the pain and complications associated with the procedure. The aim of this study was to evaluate the role of transurethral resection of the prostate(TURP) for the diagnosis of prostate cancer in patients with lower urinary tract symptoms and clinical suspicion but with negative repeat biopsy samples.
MATERIALS AND METHODS
From January 2000 to December 2006, 51 patients less than 80 years old underwent TURP at our institution for lower urinary tract symptoms with a serum PSA 4-10ng/ml and negative repeat transrectal needle biopsy of the prostate. We examined their first serum PSA, serum PSA before the TURP, PSA density, as well as their age, prostate size and digital rectal exam findings. The probability for the detection of prostate cancer by TURP was investigated retrospectively.
RESULTS
Prostate cancer was detected in seven patients(13.7%). The total Gleason score for the biopsy specimens was 5 in two patients, 6 in one patient and 7 in four patients. There were significant differences between the prostate cancer group and the benign prostate hypertrophy group with regard to the PSA density and prostate volume. However there were no significant differences between the first serum PSA and the serum PSA before TURP in the two groups.
CONCLUSIONS
In case with a high suspicion for prostate cancer, the TURP helps in the diagnosis of prostate cancer in those patients with a negative repeat biopsy and a serum PSA 4-10ng/ml and improvement of their lower urinary tract symptoms.

Keyword

Prostate cancer; Transurethral resection of prostate; Needle biopsy

MeSH Terms

Aged, 80 and over
Biopsy
Biopsy, Needle*
Diagnosis*
Humans
Hypertrophy
Lower Urinary Tract Symptoms*
Needles*
Neoplasm Grading
Patient Compliance
Prostate*
Prostatic Neoplasms*
Retrospective Studies
Transurethral Resection of Prostate

Reference

1. Terris MK. Sensitivity and specificity of sextant biopsies in the detection of prostate cancer: preliminary report. Urology. 1999; 54:486–9.

2. Bazinet M, Karakiewicz PI, Aprikian AG, Trudel C, Aronson S, Nachabe M, et al. Value of systematic transition zone biopsies in the early detection of prostate cancer. J Urol. 1996; 155:605–6.

3. Terris MK, Pham TQ, Issa MM, Kabalin JN. Routine transition zone and seminal vesicle biopsies in all patients undergoing transrectal ultrasound guided prostate biopsies are not indicated. J Urol. 1997; 157:204–6.

4. Fleshner NE, Fair WR. Indications for transition zone biopsy in the detection of prostatic carcinoma. J Urol. 1997; 157:556–8.

5. Hodge KK, McNeal JE, Terris MK, Stamey TA. Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol. 1989; 142:71–4.

6. Terris MK, Wallen EM, Stamey TA. Comparison of mid-lobe versus lateral systematic sextant biopsies in the detection of prostate cancer. Urol Int. 1997; 59:239–42.

7. Moon KH, Cheon SH, Kim CS. Systematic 10-site prostate biopsy is superior to sextant method for diagnosing carcinoma of the prostate. Korean J Urol. 2000; 41:1178–82.

8. Yeo BG, Lee ES, Byun SS. Peripheral 10 sites prostate biopsy: Is it really effective? Korean J Urol. 2003; 44:851–4.

9. Durkan GC, Sheikh N, Johnson P, Hildreth AJ, Greene DR. Improving prostate cancer detection with an extended-core transrectal ultrasonography-guided prostate biopsy protocol. BJU Int. 2002; 89:33–9.

10. Naughton CK, Miller DC, Mager DE, Ornstein DK, Catalona WJ. A prospective randomized trial comparing 6 versus 12 prostate biopsy cores: impact on cancer detection. J Urol. 2000; 164:388–92.

11. Djavan B, Ravery V, Zlotta A, Dobronski P, Dobrovits M, Fakhari M, et al. Prospective evaluation of prostate cancer detected on biopsies 1, 2, 3 and 4: when should we stop? J Urol. 2001; 166:1679–83.

12. Keetch DW, McMurtry JM, Smith DS, Andriole GL, Catalona WJ. Prostate specific antigen density versus prostate specific antigen slope as predictors of prostate cancer in men with initially negative prostatic biopsies. J Urol. 1996; 156:428–31.

13. Roehl KA, Antenor JA, Catalona WJ. Serial biopsy results in prostate cancer screening study. J Urol. 2002; 167:2435–9.

14. Merrill RM, Wiggins CI. Incidental detection of population based prostate cancer incidence rates through transurethral resection of the prostate. Urol Oncol. 2002; 7:213–9.

15. Zigeuner R, Schips L, Lipsky K, Auprich M, Salfellner M, Rehak P, et al. Detection of prostate cancer by TURP or open surgery in patients with previously negative transrectal prostate biopsies. Urology. 2003; 62:883–7.

16. Lee SC, Lee SC, Kim WJ. Value of PSA density, PSA velocity and percent free PSA for detection of prostate cancer in patients with serum PSA 4-10ng/ml patients. Korean J Urol. 2004; 45:747–52.

17. Kitamura H, Masumori N, Tanuma Y, Yanase M, Itoh N, Takahashi A, et al. Does transurethral resection of the prostate facilitate detection of clinically significant prostate cancer that is missed with systematic sextant and transition zone biopsies? Int J Urol. 2002; 9:95–9.

18. Onder AU, Yalcin V, Arar O, Yaycioglu O, Citci A, Solok V. Impact of transition zone biopsies in detection and evaluation of prostate cancer. Eur Urol. 1998; 33:542–8.

19. Reissigl A, Pointner J, Strasser H, Ennemoser O, Klocker H, Bartsch G. Frequency and clinical significance of transition zone cancer in prostate cancer screening. Prostate. 1997; 30:130–5.

20. Keetch DW, Catalona WJ. Prostatic transition zone biopsies in men with previous negative biopsies and persistently elevated serum prostate specific antigen values. J Urol. 1995; 154:1795–7.

21. Pelzer AE, Bektic J, Berger AP, Halpern EJ, Koppelstatter F, Klauser A, et al. Are transition zone biopsies still necessary to improve prostate cancer detection? Results from the tyrol screening project. Eur Urol. 2005; 48:916–21.

22. Ornstein DK, Rao GS, Smith DS, Andriole GL. The impact of systematic prostate biopsy on prostate cancer incidence in men with symptomatic benign prostatic hyperplasia undergoing transurethral resection of the prostate. J Urol. 1997; 157:880–3.

23. Ito H, Yamaguchi K, Kotake T, Matsuzaki O, Nagao K. Use-fulness of aspiration cytology in prostate cancer detection. Int Urol Nephrol. 1995; 27:93–100.

24. Niesel T, Breul J, Hartung R. Diagnostic value of additional systematic prostate biopsies in patients undergoing transurethral resection of the prostate. Urology. 1997; 49:869–73.

25. Rovner ES, Schanne FJ, Malkowicz SB, Wein AJ. Transurethral biopsy of the prostate for persistently elevated or in-creasing prostate specific antigen following multiple negative transrectal biopsies. J Urol. 1997; 158:138–41.

26. Puppo P, Introini C, Calvi P, Naselli A. Role of transurethral resection of the prostate and biopsy of the peripheral zone in the same session after repeated negative biopsies in the diagnosis of prostate cancer. Eur Urol. 2006; 49:873–8.

27. Colombo R, Naspro R, Salonia A, Montorsi F, Raber M, Suardi N, et al. Radical prostatectomy after previous prostate surgery: clinical and functional outcomes. J Urol. 2006; 176:2459–63.

28. Djavan B, Mazal P, Zlotta A, Wammack R, Ravery V, Remzi M, et al. Pathological features of prostate cancer detected on initial and repeat prostate biopsy: results of the prospective European Prostate Cancer Detection study. Prostate. 2001; 47:111–7.

29. Ryu SH, Chai SE, Choi HY. Predictive factors of prostatic cancer detection on repeat prostate biopsy. Korean J Urol. 2003; 44:1–5.

30. Durkan GC, Greene DR. Elevated serum prostate specific antigen levels in conjunction with an initial prostatic biopsy negative for carcinoma: Who should undergo a repeat biopsy? BJU Int. 1999; 83:34–8.