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

Abstract

PurposeTo identify potential predictive factors of incidental prostate cancer (IPca) in patients considering tissue-ablation treatment for benign prostatic hyperplasia (BPH).Materials and MethodsFrom the 11 centers, 1,613 men who underwent transurethral resection of the prostate (TURP) or open prostatectomy were included. Before surgery, prostate biopsy was performed in all patients with prostate-specific antigen (PSA) ≥4.0 ng/ml or with abnormal digital rectal examination (DRE) findings. The patients with prostate cancer preoperatively or with PSA >20 ng/ml were excluded. As predictive factors of IPca, age, body mass index, PSA, DRE, and transrectal ultrasonography (TRUS) findings, including total prostate volume (TPV), transition zone volume (TZV), and the presence of hypoechoic lesions, were reviewed. PSA density (PSAD) and PSAD in the transition zone (PSAD-TZV) were calculated.ResultsIPca was diagnosed in 78 patients (4.8%). DRE findings, PSA, and TZV were independent predictive factors in the multivariate analysis. In the receiver operating characteristic curve analysis of PSA, PSAD, and PSAD-TZV, the area under the curve (AUC) was the largest for PSAD-TZV (AUC, 0.685).ConclusionsIPca was detected in 4.8% of the population studied. In addition to DRE findings, the combination of TZV and PSA can be useful predictive factors of IPca in patients considering tissue-ablation treatment as well as TURP.

Preoperative parameters to predict incidental (T1a and T1b) prostate cancer

“…However, the rate of incidental prostate cancer in patients with both negative age-specific PSA levels and negative DRE findings was 6.4% (72 of 1127). Yoo and colleagues 3 reported that incidental prostate cancer was found in only 4.8% (78 of 1613) after prostate biopsy in all patients with PSA ≥4.0 ng/mL or with abnormal DRE findings. Meanwhile, despite being performed in the PSA era, our detection rate of incidental prostate cancer on TURP was slightly higher than the other reports (10.1%; 31 of 307); there are 2 possible reasons for this increase.…”

“…Prostate cancer has been found incidentally in TURP specimens without prior diagnosis in 5% to 13% of patients. [1][2][3] According to the TNM staging system, incidental tumour in less than 5% of resected prostate tissue is subclassified in clinical stage T1a; tumour found in more than 5% of resected tissue is subclassified as T1b. 4 Although most of the incidental prostate cancers are considered clinically insignificant, recent studies have suggested that in some of them, the clinical course becomes more unfavourable.…”

Clinical optimal dose of solifenacin succinate for�nursing patients after transurethral resection of the prostate during the perioperative period

“…Prostate hyperplasia is a disease that often occurs in elderly men and is caused by pathophysiological changes after urinary tract obstruction (12). Previous reports have shown that SOL is a safe and efficient treatment for patients with benign prostate hyperplasia after transurethral resection of the prostate (8,13).…”

Incidence of Carcinoma Prostate in Transurethral Resection Specimen in a Teaching Hospital of Nepal

“…13 14 A recent multi-centric review by Yoo et al showed an incidental prostate cancer rate of 4.8% in over 1600 patients. 15 They found that in addition to DRE findings, the combination of transitional zone volume and PSA could be useful predictors of incidental prostate cancer. Overall, these studies continue to support both a decreased overall prevalence of incidental prostate cancer and more specifically pT1b lesions in the modern era.…”

“…Prior to our findings, detection rates in the PSA era ranged from 4.8% to 16.7%. [8][9][10][11][13][14][15] Dellavedova et al found an incidental prostate cancer detection rate of 7% when they reviewed 100 patients who underwent bipolar TURP. 11 Six patients had Gleason grade 3+3 pT1a disease and one patient had Gleason grade 3+4 pT1b disease.…”