Probability of finding T1a and T1b (Incidental) prostate cancer during TURP has decreased in the PSA era

Abstract

The purpose of this study is to assess the likelihood of detecting stage T1a and T1b cancer in transurethral prostatectomy specimens during the PSA era. Comparison was made of transurethral resection of prostate (TURP) cohorts in the pre-PSA era (1986)(1987) and the PSA era (1994)(1995)(1996)(1997)(1998)(1999)(2000), excluding patients with known PCa. A total of 228 men without a known history of prostate cancer underwent TURP during the pre-PSA era time frame and 501 underwent the procedure during the PSA era time frame. Malignancy diagnosed at the time of TURP decreased from 14.9 to 5.2% of patients in the pre-PSA and PSA eras, respectively. Stage T1a decreased from 4.4 to 2.4% and Stage T1b decreased from 10.5 to 2.8% of patients in the pre-PSA and PSA eras, respectively (Po0.001, Fisher's exact test). Prostate cancer newly identified during TURP has decreased significantly in the era of PSA screening in our study population, with the most significant drop being in clinically significant stage T1b. The decrease in TURP rates reduces the overall incidence of T1a/b cancer but cannot explain the lower risk of detecting previously unsuspected cancer at the time of any given TURP. Identification of many men with occult prostate cancer before TURP through screening and early detection is the most likely cause of this finding. These data suggest that men considering surgical or medical management of benign prostatic hyperplasia may be informed that it should be infrequent that men properly evaluated for prostate cancer will harbor clinically significant undetected malignancy.

Incidence of Carcinoma Prostate in Transurethral Resection Specimen in a Teaching Hospital of Nepal

“…9 More recently, Jones et al found a decrease of incidental prostate cancer from 14.9% to 5.2% (pre versus post PSA era) in over 700 patients. 10 They saw significant decreases in both pT1a and pT1b incidental prostate cancer (4.4% to 2.2% and 10.5% to 2.8%, respectively) between the pre-PSA and the PSA era. Other possible reasons for the reduction in incidental prostate cancer include the decreased rate of surgical management of BPH due to increased use of medical therapy as well as an increased use of ablative therapies, which do not always provide tissue for pathologic analysis in patients who ultimately require surgical management of their BPH.…”

“…Prior to our findings, detection rates in the PSA era ranged from 4.8% to 16.7%. [8][9][10][11][13][14][15] Dellavedova et al found an incidental prostate cancer detection rate of 7% when they reviewed 100 patients who underwent bipolar TURP. 11 Six patients had Gleason grade 3+3 pT1a disease and one patient had Gleason grade 3+4 pT1b disease.…”

Active surveillance in localized prostate cancer: comparison of incidental tumours (T1a/b) and tumours diagnosed by core needle biopsy (T1c/T2a): results from the HAROW study

“…The TNM classification distinguishes stages T1a (<5% of the resected tissue) and T1b (>5% of the resected tissue) disease [1]. The incidence of IPCa has been reported to be 5.2-6.4% [2,3], but no unequivocal statement regarding the appropriate treatment has thus far been made, because only studies with small numbers of cases are currently available. For patients with IPCa and a low Gleason score (≤6) there are good reasons for proceeding with non-invasive protocols, as several studies have shown that cancer-specific survival times are approximately equal to normal life expectancy [4,5].…”

Preoperative parameters to predict incidental (T1a and T1b) prostate cancer

“…Prostate cancer has been found incidentally in TURP specimens without prior diagnosis in 5% to 13% of patients. [1][2][3] According to the TNM staging system, incidental tumour in less than 5% of resected prostate tissue is subclassified in clinical stage T1a; tumour found in more than 5% of resected tissue is subclassified as T1b. 4 Although most of the incidental prostate cancers are considered clinically insignificant, recent studies have suggested that in some of them, the clinical course becomes more unfavourable.…”