Korean J Urol.  2010 May;51(5):313-317.

The Role of TURP in the Detection of Prostate Cancer in BPH Patients with Previously Negative Prostate Biopsy

• Kim DK
• Kim SJ
• Moon HS
• Park SY
• Kim YT
• Choi HY
• Lee TY
• Park HY

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.

Keyword

Needle biopsy; Prostatic neoplasms; Transurethral resection of prostate

MeSH Terms

Biopsy
Biopsy, Needle
Digital Rectal Examination
Early Diagnosis
Humans
Lower Urinary Tract Symptoms
Prostate
Prostate-Specific Antigen
Prostatic Hyperplasia
Prostatic Neoplasms
Retrospective Studies
Transurethral Resection of Prostate
Urinary Bladder Neck Obstruction
Prostate-Specific Antigen

Reference

1. Mai KT, Isotalo PA, Green J, Perkins DG, Morash C, Collins JP. Incidental prostatic adenocarcinomas and putative premalignant lesions in TURP specimens collected before and after the introduction of prostate-specific antigen screening. Arch Pathol Lab Med. 2000; 124:1454–1456. PMID: 11035574.

2. 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 4-10 ng/ml with a negative repeat transrectal needle biopsy of prostate. Korean J Urol. 2007; 48:1010–1015.

3. Mariappan P, Chong WL, Sundram M, Mohamed SR. Increasing prostate biopsy cores based on volume vs the sextant biopsy: a prospective randomized controlled clinical study on cancer detection rates and morbidity. BJU Int. 2004; 94:307–310. PMID: 15291857.

4. O'dowd GJ, Miller MC, Orozco R, Veltri RW. Analysis of repeated biopsy results within 1 year after a non cancer diagnosis. Urology. 2000; 55:553–559. PMID: 10736500.

5. Eggener SE, Roehl KA, Catalona WJ. Predictors of subsequent prostate cancer in men with a prostate specific antigen of 2.6 to 4.0 ng/ml and an initially negative biopsy. J Urol. 2005; 174:500–504. PMID: 16006880.

6. Kwak DY, Chang HS, Park CH, Kim CI. Long-term results of transurethral resection of the prostate for large benign prostatic hyperplasia: a comparative study with open prostatectomy. Korean J Urol. 2008; 49:31–36.

7. Kim JY, Moon KH, Yoon CJ, Park TC. Bipolar transurethral resection of the prostate: a comparative study with monopolar transurethral resection. Korean J Urol. 2006; 47:493–497.

8. Kim HG, Lee BK, Paick SH, Lho YS. Efficacy of bipolar transurethral resection of the prostate: comparison with standard monopolar transurethral resection of the prostate. Korean J Urol. 2006; 47:377–380.

9. 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; 49:873–878. PMID: 16439052.

10. Fowler JE Jr, Pandey P, Bigler SA, Yee DT, Kolski JM. Trends in diagnosis of stage T1a-b prostate cancer. J Urol. 1997; 158:1849–1852. PMID: 9334615.

11. Tombal B, De Visccher L, Cosyns JP, Lorge F, Opsomer R, Wese FX, et al. Assessing the risk of unsuspected prostate cancer in patients with benign prostatic hypertrophy: a 13-year retrospective study of the incidence and natural history of T1a-T1b prostate cancers. BJU Int. 1999; 84:1015–1020. PMID: 10571626.

12. Monda JM, Barry MJ, Oesterling JE. Prostate specific antigen cannot distinguish stage T1a (A1) prostate cancer from benign prostatic hyperplasia. J Urol. 1994; 151:1291–1295. PMID: 7512660.

13. Ahn HS, Kwon CH, Joo KJ. Comparative analysis of the prostate cancer detection rate according to region and number of biopsy in patient with elevated serum PSA. Korean J Urol. 2006; 47:591–595.

14. Roehl KA, Antenor JA, Catalona WJ. Serial biopsy results in prostate cancer screening study. J Urol. 2002; 167:2435–2439. PMID: 11992052.

15. Ploussard G, Dubosq F, Boublil V, Allory Y, de la Taille AD, Vordos D, et al. Extensive biopsies and transurethral prostate resection in men with previous negative biopsies and high or increasing prostate specific antigen. J Urol. 2009; 182:1342–1349. PMID: 19683310.

16. Steuber T, Karakiewicz PI, Augustin H, Erbersdobler A, Haese A, Chun KH, et al. Transition zone cancers undermine the predictive accuracy of Partin table stage predictions. J Urol. 2005; 173:737–741. PMID: 15711259.

17. Hwang SI, Lee HJ, Cho JY, Kim SH, Lee SE, Byun SS, et al. Should transition zone biopsies be added to 12-core systematic biopsies of the prostate? J Clin Ultrasound. 2009; 37:281–284. PMID: 19309725.

18. 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; 47:111–117. PMID: 11340633.

19. Palisaar JR, Wenske S, Sommerer F, Hinkel A, Noldus J. Open radical retropubic prostatectomy gives favourable surgical and functional outcomes after transurethral resection of the prostate. BJU Int. 2009; 104:611–615. PMID: 19298408.

20. Teber D, Cresswell J, Ates M, Erdogru T, Hruza M, Gözen AS, et al. Laparoscopic radical prostatectomy in clinical T1a and T1b prostate cancer: oncologic and functional outcomes--a matched-pair analysis. Urology. 2009; 73:577–581. PMID: 19100598.

21. 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; 9:95–99. PMID: 12028299.

22. 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; 52:819–826. PMID: 17418482.