Incidental prostate cancer diagnosed after surgical treatment of benign prostatic hyperplasia

Abstract

Objective: Incidental prostate cancer (PCa) is defined as the clinically inapparent tumor detected after transurethral resection of prostate (TURP) or open prostatectomy with benign preoperative rectal examination, prostate specific antigen (PSA) and imaging. The aim of this study is to determine the incidence and clinical significance of incidental prostate cancer in our clinic. Material and Methods: A retrospective analysis was performed in patients who were treated with TURP or transvesical open prostatectomy (TVP) between January 2014 and December 2019. Age, prostate volume, preoperative PSA value, Gleason score, ISUP score, stage and presence of previous prostate biopsy were noted. Treatment performed for incidental PCA was determined. Results: A total of 1020 patients were surgically treated for benign prostate hyperplasia between January 2014 and December 2019. Incidental PCa was diagnosed in 57 (5.6%) patients. 51 (89%) of the patients had TURP and 6 (11%) had TVP. Mean age was 69.9±7.1 years and mean PSA value was 5.3±4.8 ng/ml. Majority of the patients (82.4%) had a Gleason score of 6 (3+3) and 37 (64.9%) patients were reported as stage 1a. Patients with preoperative prostate biopsy have significantly higher prostate volume and PSA values compared to the patients without biopsy (p<0.01). Active surveillance was performed in 42 patients, 2 patients underwent radical prostatectomy, 6 patients had radiotherapy and 7 patients had androgen blockade. Conclusion: We have an incidental PCa rate similar to the literature. Majority of the patients have stage 1a disease and a Gleason score of 6. Most of the patients were managed conservatively. Keywords: incidental prostate cancer, benign prostate hyperplasia, transurethral resection of prostate