Incidental prostate cancer diagnosed following a transurethral resection of the prostate: A national database analysis in England

Abstract

Objectives: The aim was to compare prostate cancer and all-cause mortality in patients diagnosed with prostate cancer following a transurethral resection of the prostate (TURP) (incidental prostate cancer, IPC), to men diagnosed with localised non-incidental prostate cancer (NIPC). Patients and methods: Men diagnosed with localised prostate cancer between 2000 and 2008 were identified from the English national cancer registry. Their records were linked to the Hospital Episode Statistics (HES) database of hospital admissions in England to identify men who had a TURP. Men were considered to have IPC if prostate cancer was diagnosed less than 60 days after TURP. Mortality rates were calculated using the Kaplan-Meier method. Mortality rate ratios (RR) comparing IPC and NIPC were calculated with multivariable Poisson regression adjusting for age group, co-morbidities, year of diagnosis and radical treatment. Results: A total of 192,960 men were included. Of these, 6666 (3.5%) had IPC and 186,294 (96.5%) NIPC. Median followup was 4.7 years (0.5-11.0). Ten-year prostate cancer mortality was 17.1% in IPC, 19.0% in NIPC. With adjustment, the prostate cancer-specific mortality in IPC was 30% lower than NIPC (RR 0.70, 95% CI 0.65-0.75, p<0.001), with no difference in all-cause mortality. Conclusion: Ten-year prostate cancer mortality in IPC was 17%. Men with IPC had lower prostate cancer-specific mortality than other prostate cancer patients.

The Influence of Endogenous Testosterone on Incidental Prostate Cancer after Transurethral Prostate Resection

“…Incidental PCA shows a specific cancer mortality rate ranging from 10 to 30% with the tumor grade being an independent prognostic factor [4,16,17]. When a diagnosis of iPCA is carried out, prostate biopsies and multiparametric resonance imaging, baseline PSA, and post-TURP PSA should be considered for a correct staging and 1.4 (0.9-4.5) grading to the residual tumor in order to plan an appropriate patients' management [18].…”

“…However, as reported in the literature, iPCA was not homogenous, since almost 40% of cases had tumor stage 1b or ISUP grade group >1. The association of endogenous TT with the risk of PCA is a controversial topic, which has not yet been settled because controlled studies are missing [4,16]. The risk of PCA may be increased, decreased, or null by endogenous TT [19,20].…”

“…The current data regarding iPCA frequency are discordant. According to recent autopsy findings, the estimated mean PCA prevalence increased from 5% at age <30 years to 59% by age >79 years [4]. Evidences reported that iPCA incidence ranges between 4 and 11% [5] and it is associated with some clinical factors such as serum leukocyte count and BMI [5].…”