Clinical Relevance of Transurethral Resection of the Prostate in “Asymptomatic” Patients with an Elevated Prostate-Specific Antigen Level

Renterghem, Koenraad van; Koeveringe, Gommert van; Achten, Ruth; Kerrebroeck, Philip Van

doi:10.1016/j.eururo.2007.03.055

Cited by 21 publications

(15 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We have shown that in those patients, bladder outlet obstruction (BOO) can be the reason for elevated and/or rising PSA levels [3] . We also demonstrated that after performing a diagnostic transurethral resection of the prostate (TURP), BPH is encountered in most of these patients (90.2%) [4] .…”

Section: Introductionmentioning

confidence: 81%

“…We believe that for the above-mentioned reasons, patients with a persistently elevated PSA and/or rising PSA which is indicative of BOO should be offered TURP [4] . Until now, there has been controversy about the value of a diagnostic TURP.…”

Section: Discussionmentioning

confidence: 99%

“…Firstly, BOO is a condition that should be cured since it can cause detrusor decompensation or renal insufficiency [16] . Secondly, a 'diagnostic' TURP has the advantage of an extensive histological examination [4] . We previously showed that approximately 10% of patients with a persistently elevated PSA and/or rising PSA, negative biopsies and BOO had PCa in the resected tissue following TURP of whom 87.5% had a significant PCa mainly located anteriorly and laterally in the peripheral zone.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Long-Term Clinical Outcome of Diagnostic Transurethral Resection of the Prostate in Patients with Elevated Prostate-Specific Antigen Level and Minor Lower Urinary Tract Symptoms

Renterghem

Koeveringe²,

Achten³

et al. 2009

Urol Int

Self Cite

View full text Add to dashboard Cite

Introduction: In patients with minor lower urinary tract symptoms (LUTS), elevated prostate-specific antigen (PSA) levels and (multiple) negative multi-site biopsies, therapy decision is complex. Long-term outcome of a diagnostic transurethral resection of the prostate (TURP) in these patients needs to be determined. Methods: We retrospectively evaluated patients with minor LUTS, elevated PSA levels (≥4 ng/ml) and no signs of prostate cancer. Patients with bladder outlet obstruction (BOO) underwent TURP. When TURP showed no malignancy, patients were annually evaluated by PSA testing and the International Prostate Symptom Score (IPSS). Results: The study included 82 consecutive patients satisfying the inclusion criteria. All patients underwent TURP. No malignancy was encountered in 74 patients (90.2%). Of this group, 36 patients were followed >3 years (mean 62.1 months). One patient (2.8%) showed a persistently rising PSA level with positive extended multi-site biopsies 4 years after TURP, implying further treatment. 35 patients (97.2%) had a permanent complete normalization of PSA levels (<4 ng/ml) together with normalized IPSS. Conclusions: We consider an elevated PSA level in patients with minor LUTS and (multiple) negative multi-site biopsies as a sign of BOO. If these patients receive a diagnostic TURP, long-term outcome is excellent.

show abstract

Section: Introductionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Long-Term Clinical Outcome of Diagnostic Transurethral Resection of the Prostate in Patients with Elevated Prostate-Specific Antigen Level and Minor Lower Urinary Tract Symptoms

Renterghem

Koeveringe²,

Achten³

et al. 2009

Urol Int

Self Cite

View full text Add to dashboard Cite

show abstract

“…For this reason, after multiple negative biopsy series, some authors have suggested to perform a TURP, even in men not complaining LUTS: Radhakrishnan et al 24 Zigeuner et al 25 and Puppo et al 3 reported a PCa detection after TURP of 21, 7.9 and 42.8%, respectively. Recently, van Renterghem et al 26 in 82 patients with minor LUTS but elevated PSA levels evaluated the clinical benefits of TURP by assessing its effect on IPSS, PSA levels and cancer detection rate: they reported an incidental PCa in 9.8% of cases, whereas PSA levels and IPSS score in patients with BPH decreased to 1.1 and 1.5 ng ml À1 , respectively.…”

Section: Discussionmentioning

confidence: 99%

Prostate cancer detection by TURP after repeated negative saturation biopsy in patients with persistent suspicion of cancer: a case–control study on 75 consecutive patients

Pepe

Fraggetta

Galia

et al. 2009

Prostate Cancer Prostatic Dis

View full text Add to dashboard Cite

To evaluate prostate cancer (PCa) detection after repeated negative saturation biopsy, 75 patients, aged 53-78 years, underwent transurethral resection of prostate (TURP) because of persistent suspicion of cancer; median PSA was 11.8 ng ml À1 and 58 men complained lower urinary tract symptoms (LUTS). In 12 (16%) and 3 (4%) men a T1a and T1b PCa was found with median PSA and Gleason score equal to 14.2 vs 23.6 ng ml À1 and 5.6 vs 7 ng ml À1 . In case of persistent suspicion of PCa after repeated negative saturation biopsy, TURP may be proposed, aside from the coexistence of LUTS, to rule out a PCa, in younger patients with high PSA values (X20 ng ml À1 ).

show abstract

“…En los pacientes asintomá-ticos algunos autores proponen la realización de RTUP, al observar que los pacientes con PSA elevado y múltiples biopsias negativas presentan en su mayoría datos urodinámicos de obstrucción infravesical 11 .…”

Section: Discussionunclassified

Importancia de la velocidad y la densidad de PSA en la predicción de cáncer de próstata en la pieza de RTU o adenomectomía de pacientes con biopsia prostática previa negativa

Alonso¹,

Blanco

López³

et al. 2008

Actas Urol Esp

View full text Add to dashboard Cite

relacionadas con el hallazgo de cáncer de próstata (CaP) en pacientes sometidos a cirugía prostática tras al menos una biopsia prostática (BP) negativa.Material y métodos: Estudio retrospectivo de 170 pacientes sometidos a resección transuretral de próstata (RTUP) o adenomectomía entre 1999 y 2007, después de una o más BPs negativas. Se realizó un análisis multivariado de regresión logística para identificar variables relacionadas con la presencia de CaP. La capacidad predictiva de PSA, PSA densidad y PSA velocidad se determinó mediante curvas ROC y su área bajo la curva (ABC). Se analizó la sensibilidad, especificidad y valores predictivos para diversos puntos de corte de PSA densidad y PSA velocidad.Resultados: Se realizó adenomectomía en 104 pacientes (61,18%) y RTUP en 66 (38,82%). Se detectó CaP en la pieza quirúrgica de 16 pacientes (9,41%). Las variables asociadas al hallazgo de CaP en la pieza quirúrgica fueron PSA densidad (OR:1,47;95%IC:1,22-6,64;p:0,007) y PSA velocidad (OR:2,87;95%IC:1,60-5,12;p<0,001). Las ABC ROC fueron 0,746, 0,793 y 0,832, para PSA, PSA densidad y PSA velocidad, respectivamente. Los puntos de corte de PSA densidad y PSA velocidad con mayor sensibilidad y especificidad en la detección de CaP fueron 0,15 y 1 ng/ml/año, respectivamente. Los pacientes sin CaP mostraron una reducción mediana de PSA de 9,35 ng/ml (-2,40 -35,40), después de la cirugía.Conclusiones: El PSA densidad y el PSA velocidad en particular, permiten predecir la presencia de CaP en la pieza de RTUP o adenomectomía, de pacientes con BPs previas negativas. La RTUP diagnóstica podría ser recomendada en pacientes con sospecha clínica de CaP, susceptibles de tratamiento curativo, con PSA velocidad >1ng/ml/año y una o más biopsias de saturación previas negativas.Palabras clave: Neoplasia de próstata. Biopsia. Resección transuretral de próstata. Antígeno prostático específico. Diagnóstico. ABSTRACT IMPORTANCE OF PSA VELOCITY AND PSA DENSITY IN THE PREDICTION OF PROSTATE CANCER IN TURP OR OPEN PROS-TATECTOMY SPECIMEN OF PATIENTS WITH PREVIOUS NEGATIVE PROSTATE BIOPSY Purpose:To determine variables related to the finding of prostate cancer (PC) in patients who underwent surgery following at least one negative prostate biopsy (PB).Materials and methods: A retrospective study of 170 patients who underwent transurethral resection of the prostate (TURP) or open prostatectomy between 1999 and 2007, following one or more negative PB sets. A multivariate logistic regression analysis was carried out in order to determine variables related to the finding of PC. The predictive capacity of PSA, PSA-density and PSA-velocity was assessed by means of ROC curves and the area under the curve (AUC). Sensitivity, specificity and predictive values were determined for several PSA-density and PSA-velocity cut-off points.Results: Open prostatectomy was carried out on 104 patients (61.18%) and TURP on 66 (38.82%). PC was detected in the surgical specimen of 16 patients (9.41%). Variables associated with the finding of PC in the surgical specimen...

show abstract

Clinical Relevance of Transurethral Resection of the Prostate in “Asymptomatic” Patients with an Elevated Prostate-Specific Antigen Level

Cited by 21 publications

References 27 publications

Long-Term Clinical Outcome of Diagnostic Transurethral Resection of the Prostate in Patients with Elevated Prostate-Specific Antigen Level and Minor Lower Urinary Tract Symptoms

Long-Term Clinical Outcome of Diagnostic Transurethral Resection of the Prostate in Patients with Elevated Prostate-Specific Antigen Level and Minor Lower Urinary Tract Symptoms

Prostate cancer detection by TURP after repeated negative saturation biopsy in patients with persistent suspicion of cancer: a case–control study on 75 consecutive patients

Importancia de la velocidad y la densidad de PSA en la predicción de cáncer de próstata en la pieza de RTU o adenomectomía de pacientes con biopsia prostática previa negativa

Contact Info

Product

Resources

About