Benign prostat hiperplazisinin cerrahi tedavisi sonrası tanı konulan insidental prostat kanseri

Abstract

Amaç: İnsidental prostat kanseri (PCa) klinik belirti vermeyen, ameliyat öncesi rektal tuşe, prostat spesifik antijen (PSA) ve görüntülemeleri normal hastalarda transüretral prostat rezeksiyonu (TURP) veya açık prostatektomi sonrası tespit edilen kanser olarak tanımlanır. Bu çalışmanın amacı kliniğimizdeki insidental PCa insidansını ve klinik anlamlılığını belirlemektir.
Gereç ve Yöntemler: Merkezimizde 2014-2019 yılları arasında benign prostat hiperplazisi ön tanısı ile TURP veya transvezikal prostatektomi (TVP) uygulanan 1020 hasta retrospektif olarak incelendi. Hastanın yaşı, prostat hacmi, preoperatif PSA değeri, Gleason skoru, ISUP skoru, evresi ve ameliyat öncesi prostat biyopsisinin varlığı not edildi. Prostat kanseri için uygulanan tedavi yöntemleri değerlendirildi.
Bulgular: Ocak 2014 ile Aralık 2019 arasında toplam 1020 hasta BPH için cerrahi olarak tedavi edildi. 57 (%5.6) hastaya insidental PCa tanısı kondu. Hastaların 51’i (% 89) TURP ve 6’sı (%11) TVP olmuştu. Ortalama yaş 69.9±7.1 yıl ve ortalama PSA değeri 5.3±4.8 ng/ml idi. Hastaların çoğunluğu (%82.4) Gleason skor 6 (3+3) ve 37’si (%64.9) evre 1a olarak rapor edildi. Preoperatif prostat biyopsisi yapılan hastaların prostat hacmi ve PSA değerleri biyopsi yapılmayanlara göre anlamlı olarak daha yüksekti (p<0.01). Toplam 42 hastada aktif izlem yapıldı, 2 hastaya radikal prostatektomi, 6 hastaya radyoterapi ve 7 hastaya androjen blokajı uygulandı.
Sonuç: Kliniğimizdeki insidental PCa oranı literatürde bildirilen oranlara benzer bulunmuştur. Hastaların çoğunda evre 1a hastalık ve Gleason 6 skoru tespit edilmiştir. İnsidental prostat kanserinin tedavisinde konservatif tedavi seçenekleri ön planda yer almaktadır.
Anahtar Kelimeler: insidental prostat kanseri, benign prostat hiperplazisi, transüretral prostat rezeksiyonu.

Keywords

• insidental prostat kanseri
• benign prostat hiperplazisi
• transüretral prostat rezeksiyonu

Incidental prostate cancer diagnosed after surgical treatment of benign prostatic hyperplasia

Abstract

Objective: Incidental prostate cancer (PCa) is defined as the clinically inapparent tumor detected after transurethral resection of prostate (TURP) or open prostatectomy with benign preoperative rectal examination, prostate specific antigen (PSA) and imaging. The aim of this study is to determine the incidence and clinical significance of incidental prostate cancer in our clinic.
Material and Methods: A retrospective analysis was performed in patients who were treated with TURP or transvesical open prostatectomy (TVP) between January 2014 and December 2019. Age, prostate volume, preoperative PSA value, Gleason score, ISUP score, stage and presence of previous prostate biopsy were noted. Treatment performed for incidental PCA was determined.
Results: A total of 1020 patients were surgically treated for benign prostate hyperplasia between January 2014 and December 2019. Incidental PCa was diagnosed in 57 (5.6%) patients. 51 (89%) of the patients had TURP and 6 (11%) had TVP. Mean age was 69.9±7.1 years and mean PSA value was 5.3±4.8 ng/ml. Majority of the patients (82.4%) had a Gleason score of 6 (3+3) and 37 (64.9%) patients were reported as stage 1a. Patients with preoperative prostate biopsy have significantly higher prostate volume and PSA values compared to the patients without biopsy (p<0.01). Active surveillance was performed in 42 patients, 2 patients underwent radical prostatectomy, 6 patients had radiotherapy and 7 patients had androgen blockade.
Conclusion: We have an incidental PCa rate similar to the literature. Majority of the patients have stage 1a disease and a Gleason score of 6. Most of the patients were managed conservatively.

Keywords

• incidental prostate cancer
• benign prostate hyperplasia
• transurethral resection of prostate

References

1. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015; 136(5):359-386.
2. Gratzke C, Bachmann A, Descazeaud A, et al. EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction. Eur Urol. 2015; 67(6):1099-1109.
3. He G, Sun C, Shu Y, et al. The diagnostic value of prostate cancer between holmium laser enucleation of the prostate and transurethral resection of the prostate for benign prostatic hyperplasia: A retrospective comparative study. Int J Surg. 2020; 79:217-221.
4. Kim DK, Kim SJ, Moon HS, et al. The Role of TURP in the Detection of Prostate Cancer in BPH Patients with Previously Negative Prostate Biopsy. Korean J Urol. 2010; 51(5):313-317.
5. Gravas S, Cornu JN, Gacci M, et al. Management of non-neurogenic male LUTS. Available from https://uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/.
6. Morita M, Matsuura T. Successful treatment of incidental prostate cancer by radical transurethral resection of prostate cancer. Clin Genitourin Cancer. 2013; 11(2):94-99.
7. Eggener SE, Roehl KA, Catalona WJ. Predictors of subsequent prostate cancer in men with a prostate specific antigen of 2.6 to 4.0 ng/ml and an initially negative biopsy. J Urol. 2005; 174(2):500-504.
8. Edge SB, Byrd DR, Compton CC, et al. AJCC cancer staging manual 7th ed. New York: Springer; 2010.

9. Cantrell BB, DeKlerk DP, Eggleston JC, Boitnott JK, Walsh PC. Pathological factors that influence prognosis in stage A prostatic cancer: the influence of extent versus grade. J Urol. 1981; 125(4):516-520.
10. Andrén O, Fall K, Franzén L, et al. How well does the Gleason score predict prostate cancer death? A 20-year follow up of a population based cohort in Sweden. J Urol. 2006; 175(4):1337-1340.
11. Herden J, Schwarte A, Boedefeld EA, Weissbach L. Active Surveillance for Incidental (cT1a/b) Prostate Cancer: Long-Term Outcomes of the Prospective Noninterventional HAROW Study. Urol Int. 2021; 105(5-6): 428-435.
12. Capogrosso P, Capitanio U, Vertosick EA, et al. Temporal Trend in Incidental Prostate Cancer Detection at Surgery for Benign Prostatic Hyperplasia. Urology. 2018; 122:152-157.
13. Abedi AR, Fallah-Karkan M, Allameh F, Ranjbar A, Shadmehr A. Incidental prostate cancer: a 10-year review of a tertiary center, Tehran, Iran. Res Rep Urol. 2018; 10:1–6.
14. Herlemann A, Wegner K, Roosen A, et al. “Finding the needle in a haystack”: oncologic evaluation of patients treated for LUTS with holmium laser enucleation of the prostate (HoLEP) versus transurethral resection of the prostate (TURP). World J Urol. 2017; 35(11):1777-1782.
15. Jones JS, Follis HW, Johnson JR. Probability of finding T1a and T1b (incidental) prostate cancer during TURP has decreased in the PSA era. Prostate Cancer Prostatic Dis. 2009; 12(1):57-60.
16. Gunda D, Kido I, Kilonzo S, et al. Prevalence and Associated Factors of Incidentally Diagnosed Prostatic Carcinoma among Patients Who Had Transurethral Prostatectomy in Tanzania: A Retrospective Study. Ethiop J Health Sci. 2018; 28(1):11–18.
17. Sakamoto H, Matsumoto K, Hayakawa N, et al. Preoperative parameters to predict incidental (T1a and T1b) prostate cancer. Can Urol Assoc J. 2014; 8(11-12):E815-820.
18. Melchior S, Hadaschik B, Thüroff S, et al. Outcome of radical prostatectomy for incidental carcinoma of the prostate. BJU Int 2009; 103(11):1478–1481.
19. Chung DY, Goh HJ, Koh DH, et al. Clinical significance of multiparametric MRI and PSA density as predictors of residual tumor (pT0) following radical prostatectomy for T1a-T1b (incidental) prostate cancer. PLoS One. 2018; 13(12):e0210037.
20. Lee LS, Thiruneelakandasivam S, Hong MK, et al. Are transrectal prostate biopsies routinely indicated in patients with incidentally diagnosed prostate cancer following transurethral resection of the prostate for benign disease? Urol Int. 2013; 91(4):397–403.
21. Matanhelia DM, Croghan S, Nason GJ, O’Connell C, Galvin DJ. The Management of Incidental Prostate Cancer Following TURP. Ir Med J. 2019; 112(2):866.
22. Chaloupka M, Figura F, Weinhold P, et al. Impact of previous transurethral prostate surgery on health-related quality of life after radical prostatectomy: Does the interval between surgeries matter? World J Urol. 2021; 39(5):1431-1438.
23. Li H, Zhao C, Liu P, et al. Radical prostatectomy after previous transurethral resection of the prostate: a systematic review and meta-analysis. Transl Androl Urol. 2019; 8(6):712–727.
24. Guilhen M, Hennequin C, Ouzaid I, et al. Urinary function and quality of life after radiotherapy for prostate cancer in patients with prior history of surgical treatment for benign prostatic hyperplasia. Radiat Oncol. 2018; 13(1):209-218.
25. Pepin A, Aghdam N, Shah S, et al. Urinary Morbidity in Men Treated with Stereotactic Body Radiation Therapy (SBRT) for Localized Prostate Cancer Following Transurethral Resection of the Prostate (TURP). Front Oncol. 2020; 10:555.