Incidence of incidental cancer in transurethral resection of prostate specimens: a 10-year retrospective analysis

Döndü Nergiz,Şenay Yıldırım,Hülya Tosun Yıldırım

doi:10.1186/s12301-021-00219-w

Abstract

BackgroundProstate cancer can be detected incidentally in patients undergoing transurethral resection of the prostate for benign prostatic hyperplasia. Therefore, it is very important that the transurethral resection of the prostate specimen is evaluated carefully for accurate grading and staging. The aim of this study was to investigate the frequency of incidental prostate cancer and its relationship with clinicopathological findings.MethodsThe study included a total of 900 patients, who underwent transurethral resection of the prostate for benign prostatic hyperplasia treatment between June 2010 and June 2020. Patient age, prostate-specific antigen (PSA) levels and resected prostate weight were assessed, and the tumor stage, Gleason grade group, lymphovascular and perineural invasion status were also evaluated in the incidental prostate cancer group. The association between these parameters and prostate cancer detection was analyzed.ResultsIncidental detection of prostate cancer was determined at the rate of 13.3%. The incidental prostate cancer group had a significantly higher mean age and PSA levels compared to the benign prostatic hyperplasia group. The weight of the resected specimen had no impact on the incidence of incidental prostate cancer. Of the total 120 incidental prostate cancer cases, 59 (49.2%) were stage T1a and 61 (50.8%) were stage T1b. No significant difference was determined between the T1 stages and age distribution, but a statistically significant difference was determined in the other clinicopathological parameters.ConclusionsThe results of this study demonstrated that the incidence of incidental prostate cancer detection was related to age and PSA levels and increased, especially in those aged ≥ 60 years and/or PSA level ≥ 4 ng/mL. To avoid overlooking incidental prostate cancer in these patients, it can be recommended that material is sufficiently sampled and carefully evaluated, and when necessary, all resected specimens are examined. Although no significant correlation was determined between specimen weight and the incidence of incidental prostate cancer, as a significant difference was determined in T1 stages, this suggests that the amount of material evaluated could change the sub-stage.

Highlights

Prostate cancer can be detected incidentally in patients undergoing transurethral resection of the prostate for benign prostatic hyperplasia
The incidental prostate cancer group had significantly higher mean age and prostate-specific antigen (PSA) levels compared to the benign prostatic hyperplasia (BPH) group (p < 0.001, p = 0.036, respectively) (Table 1)
When the mean specimen weights were compared and the specimen weight cut-off point was taken as 10 g, no statistically significant difference was determined between the incidental prostate cancer (IPC) and BPH groups (p = 0.13, p = 0.15, respectively) (Table 3)

Summary

Introduction

Prostate cancer can be detected incidentally in patients undergoing transurethral resection of the prostate for benign prostatic hyperplasia. Transurethral resection of the prostate (TUR-P) is considered the standard method of surgical treatment for benign prostatic hyperplasia (BPH) [2]. The majority of prostate cancers arise in the peripheral zones, and transrectal needle core biopsy is the gold standard for confirming the diagnosis in patients with elevated levels of PSA. Prostate cancer isolated exclusively in the transitional zone is uncommon, and a minority of tumors may not cause a rise in PSA, especially those of low volume [3, 4]. Several recent studies have reported that cancers arising from the transitional zone have a more favorable prognosis than tumors that originate in the peripheral zone [4, 5]

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