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European UrologyVolume 54, issue 6, pages 1209-1454, December 2008
Bladder Outlet Obstruction
Prospective Study of the Role of Transurethral Resection of the Prostate in Patients with an Elevated Prostate-Specific Antigen Level, Minor Lower Urinary Tract Symptoms, and Proven Bladder Outlet Obstruction
Accepted 16 June 2008, Published online 26 June 2008, pages 1385 - 1392
Deciding on strategy for patients with minor lower urinary tract symptoms (LUTS), elevated prostate-specific antigen (PSA) levels, unsuspicious digital rectal examination (DRE) and/or transrectal ultrasound (TRUS), and multiple negative extended prostate biopsies is complex.
To define the role and clinical significance of transurethral resection of the prostate (TURP) in these patients.
Design, settings, and participants
Thirty-three patients with elevated PSA; minor LUTS, as assessed by the International Prostate Symptoms Score (IPSS); no suspicion for prostate cancer on DRE and/or TRUS; and negative extended prostate biopsies were prospectively enrolled in a cohort study at a tertiary care institution.
After full urodynamic investigation showing all patients to be bladder outlet obstructed, TURP was performed.
Resected tissue was histologically examined for presence of prostate cancer. Within 6 mo after TURP, patients were clinically reevaluated by means of IPSS and PSA level.
Results and limitations
Preoperatively, mean PSA and IPSS values were 8.2 ng/ml and 6.8, respectively. Mean detrusor pressure at maximum flow was 80.3 cm H2O. Histological examination after TURP revealed benign prostate hyperplasia in 81.8% (subgroup 1) and aggressive prostate cancer in 6.1% of patients (subgroup 2). In 12.1% of patients, only a few chips of nonaggressive prostate cancer (T1a) were detected. In patients without signs of aggressive prostate cancer (93.9% = 12.1% + 81.8%, subgroup 3), mean postoperative PSA and IPSS values were 0.6 ng/ml and 2.4, respectively, while these values were 0.6 ng/ml and 2.5 ng/ml in subgroup 1 (p < 0.0001). This study is limited in sample size, requiring more research to confirm these results.
This prospective study shows that, in patients with minor LUTS and no suspicion for prostate cancer, bladder outlet obstruction can result in elevated PSA levels. These patients will benefit from TURP regarding symptomatology and supernormalisation of PSA levels. Moreover, albeit in few cases, histological examination will reveal aggressive prostate cancer.
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