Treatment of Incidental Prostate Cancer Diagnosed during BPH Surgery with Radical Prostatectomy: Appropriate or over Treatment?

Abstract

Objective: Prostate cancer is detected in pathology specimens in 3% - 16% of patients undergoing Benign Prostatic Hyperplasia (BPH) surgery. There is no consensus about the optimal treatment plan for these patients. In this study, T1a,b and T1c patients were compared oncologically and in terms of operative morbidity. Materials and Methods: This study included 54 patients (Group 1) undergoing RP based on the detection of incidental prostate cancer and 54 patients (Group 2) undergoing RP based on the diagnosis of carcinoma by biopsy in three different centers. The parameters that may affect the recurrence were investigated and compared between the two groups. Additionally, patient complaints after RP such as stress urinary incontinence, lower urinary tract symptoms and erectile dysfunction were evaluated according to questionnaires and were compared between the groups and within the group in which incidental carcinoma was identified. Data analysis was performed using SPSS version 15. Results: The mean age of the patients was 63.8 years (range 51 - 78 years) with a mean follow up of 60.4 months (range 12 - 82 months). There were statistical differences in age (p = 0.036), pre-RP PSA (p < 0.001) and pre-RP prostate volume (p < 0.001) between Group 1 and Group 2. Despite the absence of a statistically significant difference in PSM between the two groups (p = 0.09), ECE was more common in Group 2 patients (p = 0.014). None of the patients with T1a disease had biochemical recurrence which was observed in 9 patients (27.3%) with stage T1b disease (p = 0.007). There were significant differences in Gleason scores in BPH specimens and RP specimens, PSM, ECE and T stages between the two subgroups. The assessment of the morbidities that are likely to affect the quality of life by questionnaires revealed that there were no significant differences between Group 1 and Group 2 however significant differences were noted in the erection quality between the subgroups (p = 0.006). Conclusion: The course of the disease is determined by the stage of the disease (pT1a, pT1b) that indicates tumor burden in these patients. With regard to postoperative complications, the problems affecting the quality of life were not poorer in patients with T1a and T1b disease than that in patients with T1c disease, which is encouraging for radical surgery.