Nachweis von Prostatakarzinomen nach transurethraler Prostataresektion bzw. Prostataadenomektomie und vorausgegangener extendierter Stanzbiopsie

Prostate cancer commonly coexists with bladder outlet obstruction caused by benign prostatic enlargement. Especially in men with a life expectancy of at least ten years the identification of a prostate cancer would alter the decision made about which therapeutic BPH management is to use. Therefore, patients with major lower urinary tract symptoms (LUTS) presenting an elevated prostate-specific antigen (PSA) and/or a suspicious digital rectal examination finding should undergo a prostate biopsy to rule out the presence of prostatic carcinoma. In the present study, we evaluated the incidence of prostatic carcinoma detection by transurethral prostate resection or open prostatectomy after previous negative prostate biopsy. From 2005 to 2007, 113 patients, aged 49-88 years, underwent a surgical treatment (TURP or TVP) for bladder outlet obstruction with major LUTS. All these men received at least one extended prostate biopsy scheme which showed a benign histopathology in our own clinic 6 months before the surgical procedure was done. The indication for prostate biopsy was a PSA greater than 4.0 ng/ml and/or an abnormal digital rectal examination. Patients with no previous prostate biopsy received a routine 10-core prostate biopsy of the peripheral zone only. Patients with repeat biopsies received additional transition-zone biopsies. Certain clinical parameters on the risk of prostate cancer findings after surgery for bladder outlet obstruction and previous negative biopsy were evaluated, including patient age, prostatic volume, serum PSA and PSA density. For statistical calculations we used the software package SPSS version 11.0. A total of 113 consecutive men with moderate to severe bladder outflow symptoms due to BPH were treated by TURP (83 patients) or open prostatectomy (30 patients). The median and mean PSA was 11.3 and 11.9 ng/ml. An abnormal DRE was found in 11 cases. In our study 28 (24.7 %) patients had undergone at least two TRUS biopsies. The prostate volume on transrectal ultrasound ranged from 17 to 200 g with a median of 121 g. Overall, prostate cancer was detected in 10 patients (8.8%). All cancers were clinically organ confined and their Gleason score sum cores were 3 - 6. The Gleason score sum was 3 in three cases, 5 in four cases and 6 in three cases. The mean number of preoperative negative biopsies per patient was 1.3 (range 1 to 4). The likelihood of cancer was not associated with the number of previous biopsies or with the findings on digital-rectal examination (P>0.05, exact chi-square test). The probability of prostate cancer was significantly related to age (P=0.024, regression analysis). Whereas PSA, PSA density and prostate volume were not associated with cancer findings (regression analysis). The observed higher prostate cancer detection rate in some other studies examing the cancer detection findings after TURP or open prostatectomy and previous negative prostate biopsy might be due their patients received a sextant biopsy scheme, sextant biopsy of the peripheral zone with two additional transition zone biopsies or that only 4 to 6 cores were taken. This contribute to the fact that the standard sextant biopsy protocol is less effective in cancer detection than extended biopsy schemes with at least 10 cores. Despite extended prostate biopsy schemes for patients with suspected digital rectal examination or elevated PSA test a proportion of patients will still be found to have prostate cancer in the specimen following surgery for benign prostatic hyperplasia.