Risk of prostate cancer and death after benign transurethral resection of the prostate—A 20‐year population‐based analysis

Abstract

BACKGROUND:The oncological risks after benign histology on a transurethral resection of the prostate (TURP) remain largely unknown.Here, the risk of prostate cancer incidence and mortality following a benign histological assessment of TURP is investigated in a populationbased setting. METHODS: Between 1995 and 2016, 64,059 men in Denmark underwent TURP without prior biopsy of the prostate; 42,558 of these men had benign histology. The risks of prostate cancer, prostate cancer with a Gleason score ≥ 3 + 4, and prostate cancer-specific death were assessed with competing risks. Specific risks for pre-TURP prostate-specific antigen (PSA) levels at 10 and 15 years were visualized by locally estimated scatterplot smoothing. RESULTS: The median age at TURP was 72 years (interquartile range [IQR], 65-78 years), and the median follow-up was 15 years (IQR, 10-19 years). The 10-year risks of any prostate cancer and prostate cancer with a Gleason score ≥ 3 + 4 and the 15-year risk of prostate cancer death showed clear visual relations with increasing PSA. The 15-year cumulative incidence of prostate cancer-specific death after benign TURP was 1.4% (95% confidence interval [CI], 1.3%-1.6%) for all men and 0.8% (95% CI, 0.6%-1.1%) for men with PSA levels <10 ng/ml. The primary limitation was exclusion due to missing PSA data. CONCLUSIONS: Men with low PSA levels and a benign TURP can be reassured about their cancer risk and do not need to be monitored differently than any other men. Patients with high PSA levels can be considered for further follow-up with prostate magnetic resonance imaging. These findings add to the literature suggesting that normal histology from the prostate entails a low risk of death from the disease.

Comparisons of cancer-specific and overall mortality in patients with biopsy- and TURP-diagnosed prostate cancer: a population-based propensity score-matching study

“…However, direct TURP for diagnostic purposes is not recommended in patients with suspected PC who have not been screened by biopsy [1,4]. Although it was not recommended, our results, actual clinical practice, and literature report all found that many suspected PC patients were still directly undergoing TURP for treatment and diagnosis purposes [8,15]. Our study found that in the past decade, the number of patients diagnosed with TURP had increased yearly; its percentage was supposed to be more than 10%.…”

“…There are very few reports on survival outcomes of TURP-diagnosed PC. This question was answered in a recent retrospective Danish study; they included 64,059 patients with TURP, 63,781 with a final diagnosis of PC, 42,558 of whom were not screened for biopsy; they found that these patients with TPC had a shallow risk of prostate cancer-specific mortality (CSM), the 15-year cumulative incidence was 1.4% for all patients and 0.8% for patients with prostate-specific antigen (PSA) levels <10 ng/mL [8]. While their study only analyzed the survival rates of patients with a PSA of 25ng/mL and below; they also did not analyze the interval between the time of TURP and the time of diagnosis of PC, as well as did not separately analyze the prognosis of patients who underwent TURP without biopsy screening.…”

“…Although TURP for PC diagnostic purposes is not currently recommended [1], however, for patients without biopsy, TURP to relieve obstruction is permitted [4]. Many patients suspected of PC without biopsy directly undergo TURP because of bladder outlet obstruction in real-world clinical practice [8,15]. This study intended to compare CSM and overall mortality (OM) of BPC patients, to analyze the risks of mortalities in TPC patients without biopsy screening, and to guide future Clinical practice.…”

Learning Curve of Transperineal MRI/US Fusion Prostate Biopsy: 4-Year Experience

“…Prostate cancer is the most prevalent noncutaneous malignancy, and it is also the second leading cause of cancer death in males [ 1 ]. Even in men with a benign initial TURP (transurethral resection of the prostate), the 10-year accumulated incidence of prostate cancer was 4.0% [ 2 , 3 ]. In Taiwan, with the increasing use of prostate-specific antigen (PSA) screening, the incidence of prostate cancer has increased over the past decades [ 4 ].…”

Mathematical Modeling of Oncolytic Virus Therapy Reveals Role of the Immune Response

“…Cancer remains one of the leading causes of death in the US, claiming nearly 600,000 lives each year [ 1 ]. Globally, cancer accounts for almost 16% of all deaths [ 2 ]. Current treatments for cancer, such as chemotherapy, radiation therapy, and surgery, have significant physical and mental effects on the patient [ 3 ].…”