An Advanced but Traditional Technique of Transurethral Resection of the Prostate in Order not to Overlook Stage T1 Prostate Cancer

Abstract

Introduction: A little deeper resection was done during transurethral resection of the prostate (TURP) for benign prostate hyperplasia (BPH) to fill the disparities of reported prevalence rates between latent and incidental prostate cancer, as well as in order not to overlook clinically significant incidental cancer. Patients and Methods: We performed TURP in 995 patients who were diagnosed to have BPH. With a routine TUR setup, first most of the transition and central zones were resected. Then a slightly deeper resection of the residual adenoma and the peripheral zone than in the usual TURP was made. Pathological specimens were collected from 6 different parts. Results: Incidental cancer was diagnosed in 226 patients (22.7%). Gleason scores were distributed as follows: 6 or less in 150 cases (66.4%), 7 in 68 cases (30.1%), and 8 in 8 cases (3.5%). Even in the patients with lower prostate specific antigen (PSA), patients with incidental cancer and Gleason scores of 7 or more were 142 (21.2%) and 41 (28.9%) respectively at 0 < PSA < 4.0 ng/ml, and 95 (18.7%) and 26 (27.4%) respectively at 0 < PSA < 2.5 ng/ml. Multifocal/diffuse cancer was detected in 84 (37.2%) patients. Conclusions: With our method of advanced TURP, we detected incidental cancer at almost the same rate as reported in latent cancer. When TURP is performed, incidental cancer as well as to relieve voiding difficulties must not be overlooked, because there must be a considerable number of clinically significant incidental cancer of higher Gleason scores, and of multifocal/diffuse lesions.