Treatment of Incidental Prostate Cancer Diagnosed during BPH Surgery with Radical Prostatectomy: Appropriate or over Treatment?
Affiliation(s)
Ege University School of Medicine, Department of Urology, Izmir, Turkey. Hacettepe University School of Medicine, Department of Urology, Ankara, Turkey. Ankara University School of Medicine, Dep. of Urology, Ankara, Turkey.
Ege University School of Medicine, Department of Urology, Izmir, Turkey. Hacettepe University School of Medicine, Department of Urology, Ankara, Turkey. Ankara University School of Medicine, Dep. of Urology, Ankara, Turkey.
ABSTRACT
Objective: Prostate cancer is detected in pathology specimens in 3% - 16% of patients undergoing Benign Prostatic Hyperplasia (BPH) surgery. There is no consensus about the optimal treatment plan for these patients. In this study, T1a,b and T1c patients were compared oncologically and in terms of operative morbidity. Materials and Methods: This study included 54 patients (Group 1) undergoing RP based on the detection of incidental prostate cancer and 54 patients (Group 2) undergoing RP based on the diagnosis of carcinoma by biopsy in three different centers. The parameters that may affect the recurrence were investigated and compared between the two groups. Additionally, patient complaints after RP such as stress urinary incontinence, lower urinary tract symptoms and erectile dysfunction were evaluated according to questionnaires and were compared between the groups and within the group in which incidental carcinoma was identified. Data analysis was performed using SPSS version 15. Results: The mean age of the patients was 63.8 years (range 51 - 78 years) with a mean follow up of 60.4 months (range 12 - 82 months). There were statistical differences in age (p = 0.036), pre-RP PSA (p < 0.001) and pre-RP prostate volume (p < 0.001) between Group 1 and Group 2. Despite the absence of a statistically significant difference in PSM between the two groups (p = 0.09), ECE was more common in Group 2 patients (p = 0.014). None of the patients with T1a disease had biochemical recurrence which was observed in 9 patients (27.3%) with stage T1b disease (p = 0.007). There were significant differences in Gleason scores in BPH specimens and RP specimens, PSM, ECE and T stages between the two subgroups. The assessment of the morbidities that are likely to affect the quality of life by questionnaires revealed that there were no significant differences between Group 1 and Group 2 however significant differences were noted in the erection quality between the subgroups (p = 0.006). Conclusion: The course of the disease is determined by the stage of the disease (pT1a, pT1b) that indicates tumor burden in these patients. With regard to postoperative complications, the problems affecting the quality of life were not poorer in patients with T1a and T1b disease than that in patients with T1c disease, which is encouraging for radical surgery.
Objective: Prostate cancer is detected in pathology specimens in 3% - 16% of patients undergoing Benign Prostatic Hyperplasia (BPH) surgery. There is no consensus about the optimal treatment plan for these patients. In this study, T1a,b and T1c patients were compared oncologically and in terms of operative morbidity. Materials and Methods: This study included 54 patients (Group 1) undergoing RP based on the detection of incidental prostate cancer and 54 patients (Group 2) undergoing RP based on the diagnosis of carcinoma by biopsy in three different centers. The parameters that may affect the recurrence were investigated and compared between the two groups. Additionally, patient complaints after RP such as stress urinary incontinence, lower urinary tract symptoms and erectile dysfunction were evaluated according to questionnaires and were compared between the groups and within the group in which incidental carcinoma was identified. Data analysis was performed using SPSS version 15. Results: The mean age of the patients was 63.8 years (range 51 - 78 years) with a mean follow up of 60.4 months (range 12 - 82 months). There were statistical differences in age (p = 0.036), pre-RP PSA (p < 0.001) and pre-RP prostate volume (p < 0.001) between Group 1 and Group 2. Despite the absence of a statistically significant difference in PSM between the two groups (p = 0.09), ECE was more common in Group 2 patients (p = 0.014). None of the patients with T1a disease had biochemical recurrence which was observed in 9 patients (27.3%) with stage T1b disease (p = 0.007). There were significant differences in Gleason scores in BPH specimens and RP specimens, PSM, ECE and T stages between the two subgroups. The assessment of the morbidities that are likely to affect the quality of life by questionnaires revealed that there were no significant differences between Group 1 and Group 2 however significant differences were noted in the erection quality between the subgroups (p = 0.006). Conclusion: The course of the disease is determined by the stage of the disease (pT1a, pT1b) that indicates tumor burden in these patients. With regard to postoperative complications, the problems affecting the quality of life were not poorer in patients with T1a and T1b disease than that in patients with T1c disease, which is encouraging for radical surgery.
Cite this paper
A. Simsir, B. Akdogan, C. Cal, S. Baltaci and H. Ozen, "Treatment of Incidental Prostate Cancer Diagnosed during BPH Surgery with Radical Prostatectomy: Appropriate or over Treatment?," Journal of Cancer Therapy, Vol. 3 No. 4, 2012, pp. 256-262. doi: 10.4236/jct.2012.34036.
A. Simsir, B. Akdogan, C. Cal, S. Baltaci and H. Ozen, "Treatment of Incidental Prostate Cancer Diagnosed during BPH Surgery with Radical Prostatectomy: Appropriate or over Treatment?," Journal of Cancer Therapy, Vol. 3 No. 4, 2012, pp. 256-262. doi: 10.4236/jct.2012.34036.
References
[1] J. Rassweiler, D. Teber, R. Kuntz and R. Hofmann, “Complications of Transurethral Resection of the Prostate (TURP): Incidence, Management, and Prevention,” European Urology, Vol. 50, No. 5, 2006, pp. 969-979. doi:10.1016/j.eururo.2005.12.042 [2] H. Lepor, R. S. Owens, V. Rogenes and E. Kuhn, “Detection of Prostate Cancer in Males with Prostatism,” The Prostate, Vol. 25, No. 3, 1994, pp. 132-140. doi:10.1002/pros.2990250304 [3] R. M. Merrill and C. L. Wiggins, “Incidental Detection of Population-Based Prostate Cancer Incidence Rates through Transurethral Resection of the Prostate,” European Urology, Vol. 7, No. 5, 2002, pp. 213-219. doi:10.1016/S1078-1439(02)00193-X [4] D. G. Bostwick, W. H. Cooner, L. Denis, G. W. Jones, P. T. Scardino and G. P. Murphy, “The Association of Benign Prostatic Hyperplasia and Cancer of the Prostate,” Cancer, Vol. 70, No. S1, 1992, pp. 291-301. doi:10.1002/1097-0142(19920701)70:1+<291::AID-CNCR2820701317>3.0.CO;2-4 [5] F. J. Bianco Jr, P. T. Scardino and J. A. Eastham, “Radical Prostatectomy: LongTerm Cancer Control and Recovery of Sexual and Urinary Function (‘Trifecta’),” Urology, Vol. 66, No. 5, 2005, pp. 83-94. doi:10.1016/j.urology.2005.06.116 [6] U. Capitanio, V. Scattoni, M. Freschi, et al., “Radical Prostatectomy for Incidental (Stage T1a-T1b) Prostate Cancer: Analysis of Predictors for Residual Disease and Biochemical Recurrence,” European Urology, Vol. 4, No. 1, 2008, pp. 118-125. doi:10.1016/j.eururo.2008.02.018 [7] W. J. Catalona, J. P. Richie, F. R. Ahmann, et al., “Comparison of Digital Rectal Examination and Serum Prostate Specific Antigen in the Early Detection of Prostate Cancer: Results of a Multicenter Clinical Trial of 6630 Men,” The Journal of Urology, Vol. 151, No. 5, 1994, pp. 1283-1290. [8] I. M. Thompson, D. K. Pauler, P. J. Goodman, et al., “Prevalence of Prostate Cancer among Men with a Prostate-Specific Antigen Level < or = 4.0 ng per Milliliter,” The New England Journal of Medicine, Vol. 27, No. 350, 2004, pp. 2239-2246. doi:10.1056/NEJMoa031918 [9] T. A. Stamey, F. S. Freiha, J. McNeal, et al., “Localized Prostate Cancer. Relationship of Tumor Volume to Clinical Significance for Treatment of Prostate Cancer,” Cancer, Vol. 71, No. S3, 1993, pp. 933-938. doi:10.1002/1097-0142(19930201)71:3+<933::AID-CNCR2820711408>3.0.CO;2-L [10] W. J. Catalona, A. W. Partin, K. M. Slawin, et al., “Use of the Percentage of Free Prostate-Specific Antigen to enhance Differentiation of Prostate Cancer from Benign Prostatic Disease: A Prospective Multicenter Clinical Trial,” The Journal of the American Medical Association, 1998, Vol. 279, No. 19, pp. 1542-1547. doi:10.1001/jama.279.19.1542 [11] G. Aus, C. C. Abbou, M. Bolla, et al., “EAU Guidelines on Prostate Cancer,” European Urology, Vol. 48, No. 4, 2005, pp. 546-551. doi:10.1016/j.eururo.2005.06.001 [12] M. W. Kattan, T. M. Wheeler and P. T. Scardino, “Postoperative Nomogram for Disease Recurrence after Radical Prostatectomy for Prostate Cancer,” Journal of Clinical Oncology, Vol. 17, No. 5, 1999, pp. 1499-1507. [13] G. W. Hull, F. Rabbani, F. Abbas, T. M. Wheeler, M. W Kattan and P. T. Scardino, “Cancer Control with Radical Prostatectomy alone 1000 Consecutive Patients,” The Journal of Urology, Vol. 167, No. 2, 2002, pp. 528-534. doi:10.1016/S0022-5347(01)69079-7 [14] R. M. Benoit, M. J Naslund and J. Cohen, “Complications after Radical Retropubic Prostatectomy in the Medicare Population,” Urology, Vol. 56, No. 1, 2000, pp. 116-120. doi:10.1016/S0090-4295(00)00539-2 [15] H. W. Herr, “Quality of Life of ?ncontinent Men after Radical Prostatectomy,” The Journal of Urology, Vol. 151, No. 3, 1994, pp. 652-654. [16] H. C Klinger and M. Marberger, “Incontinence after Radical Prostatectomy: Surgical Treatment Options,” Current Opinion in Urology, Vol. 16, No. 2, 2006, pp. 60-64. [17] I. M. Thompson and E. J. Zeidman, “Extended Follow up of Stage A1 Carcinoma of Prostate,” Urology, Vol. 33, No. 6, 1989, pp. 455-458. doi:10.1016/0090-4295(89)90128-3 [18] K. Bandhauer and E. Senn, “Radical Retropubic Prostatectomy after Transurethral Prostatic Resection,” European Urology, Vol. 15, No. 6, 1988, pp. 180-181. [19] M. V. Catarin, G. M. Manzano, J. A. Nóbrega, F. G. Almeida, M. Srougi and H. Bruschini, “The Role of Membranous Urethral Afferent Autonomic Innervation in the Continence Mechanism after Nerve Sparing Radical Prostatectomy: A Clinical and Prospective Study,” The Journal of Urology, Vol. 180, No. 6, 2008, pp. 2527-2531. doi:10.1016/j.juro.2008.08.020
[1] J. Rassweiler, D. Teber, R. Kuntz and R. Hofmann, “Complications of Transurethral Resection of the Prostate (TURP): Incidence, Management, and Prevention,” European Urology, Vol. 50, No. 5, 2006, pp. 969-979. doi:10.1016/j.eururo.2005.12.042 [2] H. Lepor, R. S. Owens, V. Rogenes and E. Kuhn, “Detection of Prostate Cancer in Males with Prostatism,” The Prostate, Vol. 25, No. 3, 1994, pp. 132-140. doi:10.1002/pros.2990250304 [3] R. M. Merrill and C. L. Wiggins, “Incidental Detection of Population-Based Prostate Cancer Incidence Rates through Transurethral Resection of the Prostate,” European Urology, Vol. 7, No. 5, 2002, pp. 213-219. doi:10.1016/S1078-1439(02)00193-X [4] D. G. Bostwick, W. H. Cooner, L. Denis, G. W. Jones, P. T. Scardino and G. P. Murphy, “The Association of Benign Prostatic Hyperplasia and Cancer of the Prostate,” Cancer, Vol. 70, No. S1, 1992, pp. 291-301. doi:10.1002/1097-0142(19920701)70:1+<291::AID-CNCR2820701317>3.0.CO;2-4 [5] F. J. Bianco Jr, P. T. Scardino and J. A. Eastham, “Radical Prostatectomy: LongTerm Cancer Control and Recovery of Sexual and Urinary Function (‘Trifecta’),” Urology, Vol. 66, No. 5, 2005, pp. 83-94. doi:10.1016/j.urology.2005.06.116 [6] U. Capitanio, V. Scattoni, M. Freschi, et al., “Radical Prostatectomy for Incidental (Stage T1a-T1b) Prostate Cancer: Analysis of Predictors for Residual Disease and Biochemical Recurrence,” European Urology, Vol. 4, No. 1, 2008, pp. 118-125. doi:10.1016/j.eururo.2008.02.018 [7] W. J. Catalona, J. P. Richie, F. R. Ahmann, et al., “Comparison of Digital Rectal Examination and Serum Prostate Specific Antigen in the Early Detection of Prostate Cancer: Results of a Multicenter Clinical Trial of 6630 Men,” The Journal of Urology, Vol. 151, No. 5, 1994, pp. 1283-1290. [8] I. M. Thompson, D. K. Pauler, P. J. Goodman, et al., “Prevalence of Prostate Cancer among Men with a Prostate-Specific Antigen Level < or = 4.0 ng per Milliliter,” The New England Journal of Medicine, Vol. 27, No. 350, 2004, pp. 2239-2246. doi:10.1056/NEJMoa031918 [9] T. A. Stamey, F. S. Freiha, J. McNeal, et al., “Localized Prostate Cancer. Relationship of Tumor Volume to Clinical Significance for Treatment of Prostate Cancer,” Cancer, Vol. 71, No. S3, 1993, pp. 933-938. doi:10.1002/1097-0142(19930201)71:3+<933::AID-CNCR2820711408>3.0.CO;2-L [10] W. J. Catalona, A. W. Partin, K. M. Slawin, et al., “Use of the Percentage of Free Prostate-Specific Antigen to enhance Differentiation of Prostate Cancer from Benign Prostatic Disease: A Prospective Multicenter Clinical Trial,” The Journal of the American Medical Association, 1998, Vol. 279, No. 19, pp. 1542-1547. doi:10.1001/jama.279.19.1542 [11] G. Aus, C. C. Abbou, M. Bolla, et al., “EAU Guidelines on Prostate Cancer,” European Urology, Vol. 48, No. 4, 2005, pp. 546-551. doi:10.1016/j.eururo.2005.06.001 [12] M. W. Kattan, T. M. Wheeler and P. T. Scardino, “Postoperative Nomogram for Disease Recurrence after Radical Prostatectomy for Prostate Cancer,” Journal of Clinical Oncology, Vol. 17, No. 5, 1999, pp. 1499-1507. [13] G. W. Hull, F. Rabbani, F. Abbas, T. M. Wheeler, M. W Kattan and P. T. Scardino, “Cancer Control with Radical Prostatectomy alone 1000 Consecutive Patients,” The Journal of Urology, Vol. 167, No. 2, 2002, pp. 528-534. doi:10.1016/S0022-5347(01)69079-7 [14] R. M. Benoit, M. J Naslund and J. Cohen, “Complications after Radical Retropubic Prostatectomy in the Medicare Population,” Urology, Vol. 56, No. 1, 2000, pp. 116-120. doi:10.1016/S0090-4295(00)00539-2 [15] H. W. Herr, “Quality of Life of ?ncontinent Men after Radical Prostatectomy,” The Journal of Urology, Vol. 151, No. 3, 1994, pp. 652-654. [16] H. C Klinger and M. Marberger, “Incontinence after Radical Prostatectomy: Surgical Treatment Options,” Current Opinion in Urology, Vol. 16, No. 2, 2006, pp. 60-64. [17] I. M. Thompson and E. J. Zeidman, “Extended Follow up of Stage A1 Carcinoma of Prostate,” Urology, Vol. 33, No. 6, 1989, pp. 455-458. doi:10.1016/0090-4295(89)90128-3 [18] K. Bandhauer and E. Senn, “Radical Retropubic Prostatectomy after Transurethral Prostatic Resection,” European Urology, Vol. 15, No. 6, 1988, pp. 180-181. [19] M. V. Catarin, G. M. Manzano, J. A. Nóbrega, F. G. Almeida, M. Srougi and H. Bruschini, “The Role of Membranous Urethral Afferent Autonomic Innervation in the Continence Mechanism after Nerve Sparing Radical Prostatectomy: A Clinical and Prospective Study,” The Journal of Urology, Vol. 180, No. 6, 2008, pp. 2527-2531. doi:10.1016/j.juro.2008.08.020