TURP useful for excluding prostate cancer after negative biopsy
MedWire News: Men with repeated negative biopsy results but persistent indications of prostate cancer may best have the disease ruled out by transurethral resection of the prostate (TURP), report Italian researchers.
TURP picked up 15 incidences of prostate cancer in 75 men with raised prostate-specific antigen (PSA) levels who had repeated negative biopsy results.
“To improve the diagnostic accuracy, some determinants of PSA kinetics (free-to-total PSA ratio, PSA density, PSA velocity, and PSA doubling time) along with extended biopsy protocols have been introduced,” say Pietro Pepe and colleagues, from Cannizzaro Hospital in Catania.
The researchers evaluated prostate cancer detection after TURP in men with negative digital rectal examinations, but a persistent suspicion of prostate cancer after a second negative saturation biopsy (SPBx).
The median PSA among the cohort was 11.8 ng/ml and patients were recommended for TURP if their PSA level was above 10 ng/ml. The TURP procedure was performed an average of 4 months after SPBx.
Prostate cancer was found in 15 (20%) patients; their average PSA level was 15.7 ng/ml and average Gleason score was 5.9. The remaining patients were diagnosed with a benign pathology and had a median PSA level of 10.8 ng/ml.
Of the men diagnosed with cancer, 12 had stage T1a and three had stage T1b tumors. The three men with the higher-grade disease were treated with radical prostatectomy and all had recovered urinary continence within 5 months of surgery.
The men with stage T1a pathology were each enrolled into a watchful waiting protocol, and after 24 months, had a median PSA of 0.9 ng/ml.
This stable, low-level PSA after 2 years of follow-up suggested to the researchers that “cancer was localized exclusively in the removed parenchyma of the transition zone” on TURP biopsy.
Pepe et al conclude: “Although TURP detected only a negligible proportion of clinically significant cancer in case of persistent suspicion of prostate cancer… [it] could be proposed as part of the diagnostic procedure to rule out prostate cancer, besides lower urinary tract symptoms, especially in patients with high PSA values and life expectancy above 10 years.”
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By Sarah Guy