Incidental prostate cancer: Predictors of progression and strategies of management based on prostate-specific antigen

We studied predictors for the progression of incidental prostate cancer (PCa) to optimize the management strategies that are still controversial in the era of prostate-specific antigen (PSA). We performed advanced transurethral resection of the prostate (TURP) in 995 patients with benign prostate hyperplasia (BPH). Of these, 226 patients (22.7%) had incidental PCa. Included in the present study were 146 patients followed up for two years or longer. In the treated group of 26 patients whose PSA elevated, we performed radical transurethral resection of PCa (TURPCa) in 23 patients, palliative TURP in one, and endocrine therapy in two. Between the observed and treated groups, statistical differences were noted in PSA related parameters: preoperative PSA (Pre PSA), PSA three months after surgery (Post PSA), % Post PSA/Pre PSA (%PSA ratio), and PSA density (PSAD). No differences were noted in the clinical stage (T1a, T1b) and Gleason scores. Of 23 patients underwent radical TURPCa, one had pT0 disease, one showed PSA failure, and 19 had stable PSA. It may be rational and practical to decide the treatment strategy of incidental PCa based on PSA changes before and after TURP rather than Gleason scores or clinical stages.