Should all specimens taken during surgical treatment of patients with benign prostatic hyperplasia be assessed by a pathologist?

Abstract

IntroductionIn some patients submitted to transurethral resection of the prostatic (TURP) or prostatectomy (OAE) due to benign prostate hyperplasia (BPH), pathological evaluations (PE) revealed coexistence of prostate cancer (PCa) and BPH. The aim of the study is to evaluate the incidence of PCa diagnosed incidentally in prostate specimens taken during BPH surgery, to assess the need of routine PE and to define the group of patients in whom PE could be abandoned without the risk of omitting clinically significant PCa.Material and methods968 consecutive men were subjected to surgical treatment due to BPH in Jan. 2004–Sep. 2010.Results823 (85%) underwent TURP and 145 (15%) OAE. Incidental (Inc) PCa was diagnosed in 34(3.5%) pts. T1a and T1b stages were determined in 19 (2%) and 15 (1.5%) cases. Preoperative prostate biopsy due to abnormal prostate specific antigen (PSA) or digital rectal exam (DRE) was performed in 85 (8.8%) pts. Of PCa pts, 7 (20.58%) had undergone a cancer negative biopsy preoperatively. In BPH pts, 78 (8.35%) had undergone a prostate biopsy previously (p <0.01). Univariate and logit regression analyses had not revealed any correlations between age, Pv, serum PSA and frequency of IncPCa. The difference in rate of PCa diagnosed in patients with PSAD ≥0.15 and <0.15 was 8 pts (14.04%) and 20 pts (4.05%), respectively (p <0.001). Gls in those pts was >6 only in 4 cases.ConclusionsDespite the fact of low PCa detection rate observed in our study, this condition was clinically relevant in 15 (1.5%) subjects. It is difficult to establish any cut off values of pts’ age, Pv, serum PSA level suggestive of negligible risk for prostate cancer.

Prevalence and risk factors of incidental prostate cancer in certain surgeries for benign prostatic hyperplasia: A systematic review and meta-analysis

“…Overall, the basic characteristics of the included studies are illustrated in Table-1. The included studies (21) were retrospective studies (8,16,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(32)(33)(34)(35)(36)(37), 1 was a prospective study (31), and 1 was a cross-sectional study (17) that were published between 2005 and 2021, with sample sizes ranging from 120 patients to 76.788 patients. Furthermore, mean age ranged from 66 years to 75.8 years, mean prostate volume ranged from 44.2mL to 110mL, and mean PSA level ranged from 2.9ng/mL to 21.47ng/mL.…”

“…In general, the methodological quality of the included studies was evaluated on the basis of the NOS. One study (31) acquired eight points and were considered high quality, twenty one studies (8,16,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(32)(33)(34)(35)(36)(37) acquired six or seven points and were considered moderate quality, and the remaining study (17) scored three and was considered low quality (Supplementary Material 2).…”

Costs in medicine – the lesser of two evil

“…We deeply acknowledge the thoughtful editorial by Prof. Mark Soloway [ 1 ] written in response to the article published in a recent edition of CEJU [ 2 ] and agree with the statement that it is better to have a pathological report instead of having only preoperative diagnostics. The purpose of the study was to establish the subgroup of surgically managed patients due to BPH who might be spared the histologic evaluation of the specimen, yet have no compromise in the diagnosis of contingent cancer (PCa – prostate cancer).…”

Pathology examination cannot be done without a urologist's help

“…The authors of this article give us a provocative title “Should all specimens taken during surgical treatment of patients with BPH be assessed by a pathologist?” [ 1 ].…”