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N27 Is there a need of routine pathological examination of all tissue specimens taken during benign prostate hyperplasia surgery?

      Introduction and Objectives

      In 2.8–9.8% of patients (pts) undergoing TURP or prostatectomy (PR) due to benign prostate hyperplasia (BPH) final pathological evaluation (PE) reveals coexistence of prostate cancer (PCa). WHO 2002 TNM classification defines pT1a and pT1b depending on the amount of cancerous tissue in the specimen <5% and >5%, respectively. However, PCa in 85% occurs in peripheral zone, which is not usually a target of BPH surgery. Moreover, the majority of PCa patients can be excluded from BPH group based on tests performed preoperatively: PSA and TRUS-core Bx. An important question arises, whether tissue specimens taken during surgery should always be examined. The aim was to evaluate the incidence of PCa diagnosed incidentally in prostate specimens taken during BPH surgery, to assess the need of routine PE and to define the group of patients, in whom PE could be abandoned without the risk of omitting coexistence of clinically significant PCa.

      Material and Methods

      633 consecutive men aged 32–94 (mean age 70) treated due to BPH with TURP (86%) or PR (24%) in 5-year period (2004–2008) were enrolled. Mean values of prostate volume (Pv), serum PSA and PSA density (PSAD) were as follows: 71.44 (10–298) ml, 4.87 ng/ml (0.04–40.84), 0.08 (0.01–1.16). All specimens taken during TURP and PR were evaluated pathologically. Moreover, in 39 pts (6.1%) result of preoperative TRUS-core Bx was negative.

      Results

      PCa was found in 25 (3.9%) pts, less frequently after TURP (3.85%) than after PR (4.5%). PCa was staged as pT1a or pT1b in 9 (36%) and 16 (64%) cases, respectively. PCa grade defined in Gleason score (Gl.) as high risk (≥7) was diagnosed in 5 pts (20%) and all of them underwent TURP. PE in all pts, who underwent biopsy of the prostate before surgery, did not reveal cancer. Mean values of age, prostate volume (Pv), serum PSA level and PSA density (PSAD) in men with PCa and in men, in whom PCa was not found, did not differ significantly and were as follows: age – 74.76 (49–81) versus 70.14 (32–94) years, Pv – 102.44 (17–287) vs. 71.29 (10–298) ml, PSA – 2.92 (1.35–6.23) vs. 4.93 (0.04–40.84) ng/ml, PSAD – 0.04 (0.01–0.06) vs. 0.07 (0.01–1.16) ng/ml/ml, respectively. Additional treatment after BPH surgery was offered to 5 pts (20%), suffering from clinically significant PCa (pT1b, Gl. ≥7, age <70).

      Conclusions

      Incidence of PCa diagnosed incidentally in prostate specimens taken during BPH surgery is low (3.9%). A vast majority (80%) of PCa are low risk tumors (Gl. <7). However, it is difficult to establish any cut-off values of age, prostate volume, PSA or PSAD suggestive for the negligible risk of prostate cancer. Presented data suggest that PE of specimens taken during BPH surgery may be omitted especially in patients, in whom preoperative TRUS-core Bx were negative. Our results bring existing PE standards up for discussion.