[Clinical relevance of incidental prostate carcinoma. A retrospective study]

Between July 1973 and December 1992, 5156 men underwent either TURP (n = 4259) or open prostatectomy (n = 897) because of infravesical obstruction supposedly due to benign prostatic hyperplasia (BPH). In this retrospective study, 86 men in whom an incidental carcinoma of the prostate had been found were followed up. Thirty-seven cases had been classified as pT1a tumor and 49 cases as pT1b tumor; 73 patients had undergone TURP and 13 open surgery. The mean age of the patients was 70.6 years (range 54-89). Twenty-seven patients (73%) with a pT1a tumor and 19 patients (38.8%) with a pT1b carcinoma received no further treatment. Radical prostatectomy was performed in four cases, one of pT1a and three of pT1b tumor. In all other cases the patients received androgen deprivation, and in four cases external radiotherapy was applied. With a mean follow-up of 5 years (range 17-229 months) 48 patients died (55.8%). The median survival was 73 months (95% CI: 52; 89). Compared to the overall population in the same age range, the standard mortality rate (SMR) was 1.72 and 2.05 (95% CI: 1.23; 2.21 and 1.46; 2.64 respectively) using the "Allgemeine Sterbetafel" of the Federal Republic of Germany (1949-1951 and 1986-1988). Using the log-rank test (P = 0.5, two-sided) no difference in survival was found between patients staged pT1a and pT1b. Ten of 48 patients dead at the time of evaluation died of prostate cancer. This means that 20.8% (pT1a n = 3; pT1b n = 7) of the patients succumbed to progressive disease during follow-up. All four patients who underwent radical prostatectomy are free of tumor at time of this evaluation. These results are in accordance with other studies. In younger men with incidental carcinoma of the prostate and life expectancy of more than 10 years, radical surgery of the prostate should be recommended.