Introduction
: Prostate cancer is the second most common noncutaneous cancer in men, with a lifetime risk of 16%. The incidental discovery of prostate cancer during surgical treatment for benign prostatic hyperplasia (BPH) indicates the significant worldwide occurrence of this disease. This study evaluated the incidence of prostate cancer in specimens of prostate obtained during prostatectomy or trans-urethral resection of the prostate (TURP) for benign diagnoses.
Methods
Review of all TURP and open prostatectomy specimens obtained for benign pathologies at two tertiary hospitals between January 2015 and October 2022. The preoperative clinical characteristics, pathology reports, and Gleason scores were retrieved for all patients. The primary outcome was the incidence of incidental prostate cancer. Univariable logistic regressions were performed to assess associations between prostate-specific antigen (PSA) levels, preoperative clinical characteristics of patients, and primary .
Results
The study included 153 patients ranging in age from 47 to 97 years whose procedures were performed for benign diagnoses. Prostate cancer was diagnosed in six individuals (6/153) (4%). The Gleason score varied, ranging from 3 + 3 = 6 to 4 + 5 = 9. The patients' disease stages included pT1a, pT1b, pT1c, and T3N1M0. Active surveillance was chosen for three of the patients, while the remaining three underwent androgen deprivation therapy (ADT). Preoperative hematuria and low back pain were found to be independent predictors of incidental prostate cancer. All incidental prostate cancers were found in patients with PSA levels higher than 4 ng/mL.
Conclusion
There is a low rate of incidental prostate cancer among surgical specimens from patients treated for BPH, and core needle biopsies can be omitted for patients with a PSA lower than 4 ng/ml and without clinical signs suggestive of metastasis or invasion like, such as low back pain and hematuria. In addition to a low rate, only one-third of diagnosed patients required actual treatment. Prospective and more extensive studies are recommended to guide systematic histopathological review of surgical specimens from patients with BPH.