Does transurethral resection of the prostate facilitate detection of clinically significant prostate cancer that is missed with systematic sextant and transition zone biopsies?

Abstract

Background : A prospective study was conducted to determine whether transurethral resection of the prostate (TURP) facilitates detection of prostate cancer that is missed with systematic sextant biopsies associated with transition zone (TZ) biopsies. Methods : A total of 139 consecutive patients underwent transperineal TZ biopsies of each lobe in addition to a transrectal systematic sextant peripheral zone (PZ) biopsy. Patients whose biopsies were negative for cancer received TURP for relief of lower urinary tract obstruction when indicated.Results : Cancer was detected in biopsy specimens of 40 patients. Of these cancers, 18 originated in the PZ alone and 22 were located both in the TZ and the PZ. No cancers were detected in the TZ alone. Of 99 patients who were proven not to have cancer by the biopsies, 18 were indicated for TURP. Five of these patients (28%) had cancer in the resected tissues. All cancers were clinically organ confined and their Gleason sum scores were 2-5. Cancer-positive chips accounted for less than 10% of all resected specimens. Of the 66 patients with negative biopsies and without indication for TURP, four (6%) were revealed to have an elevation of the serum PSA level during follow up. They were later proven to have cancer by a second biopsy. Conclusion : Routine use of TZ biopsy is not warranted for detection of cancer. Transurethral resection of the prostate can detect cancers in patients with negative PZ and TZ biopsies. However, cancers detected by TURP may not always be clinically significant and only four of 66 patients who were not indicated for TURP and received a close follow up were later found to have cancer, although their follow-up period was short. Thus, it still remains to be elucidated whether TURP is necessary for all patients with negative biopsies of the prostate.

Impact of extended prostate biopsy including apical anterior region for cancer detection and prediction of surgical margin status for radical prostatectomy

“…Previously, we reported the results of transrectal 6-core biopsy from the PZ and transperineal 2-core biopsy from the TZ. No cancers were detected in the TZ alone (20). In contrast, Ishizuka et al reported that the cancer detection rate in the TZ alone was relatively high (8%) with transrectal sextant and four additional TZ biopsies (21).…”

Comparison of Transrectal Prostate Biopsy Results with Histology of Transurethral Resection of the Prostate in Men Undergoing High-Intensity Focused Ultrasound

“…While TURP can frequently detect cancer even in cases with negative biopsies, it may reveal that some of the cancers are clinically insignificant, as postulated in a study by Kitamura et al [14]. They detected small-volume cancer in 2 of 18 patients who underwent radical prostatectomy after TURP (0.49 and 0.36 cm 3 ).…”

Rising PSA in patients with minor LUTS without evidence of prostatic carcinoma: a missing link?

“…Greene showed that transition zone PCa is frequently associated with larger and high-grade PCa in the peripheral zone [23]. Furthermore a subset of PCas located in the transition zone can be aggressive [24][25][26]. To date, there have been no studies investigating the diagnostic yield of PCa in men with minor LUTS [27,28].…”