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Prostate cancer detection in candidates for open prostatectomy
J E Fowler1, S A Bigler, J M Kolski
1Department of Pathology, University of Mississippi School of Medicine, Veterans Affairs Medical Center, Jackson, USA.
The Journal of Urology
|November 17, 1998
Summary
Over 10% of men with elevated prostate-specific antigen (PSA) and benign prostatic hyperplasia (BPH) symptoms undergoing prostatectomy have biopsy-detectable prostate cancer. Preoperative biopsy is recommended to prevent surgical complications during open enucleation.
Area of Science:
- Urology
- Oncology
- Pathology
Background:
- Benign prostatic hyperplasia (BPH) and elevated prostate-specific antigen (PSA) are common in men undergoing prostatectomy.
- Distinguishing BPH from prostate cancer is crucial for surgical planning.
Purpose of the Study:
- To determine the incidence of biopsy-detectable prostate cancer in men with clinical BPH and elevated PSA.
- To analyze the histology of prostate tissue in men undergoing surgery.
Main Methods:
- 128 men with obstructive voiding symptoms, elevated PSA (>4.0 ng/ml), and large prostate volume (≥75 ml) underwent sextant peripheral zone biopsies.
- 59 patients also had transition zone biopsies.
- Key metrics included PSA, PSA density, and percent free PSA.
Main Results:
- 16 out of 128 patients (13%) had malignant biopsies, with one case detected only in the transition zone.
- Prostatectomy specimens revealed stage T1a cancer in 6 patients (11%) and stage T1b in 2 patients (4%).
- No significant differences in PSA, PSA density, or percent free PSA were found between benign and malignant biopsies in men without catheters.
Conclusions:
- Over 10% of men with elevated PSA considered for open prostatectomy have biopsy-detectable prostate cancer.
- Preoperative peripheral zone biopsy may be justified to avoid surgical misadventure during open enucleation.
- Less than 5% of patients with benign peripheral zone biopsies have large tumors complicating surgery.