Prostate cancer as incidental finding in transurethral resection.

UNLABELLED Prostate adenocarcinoma is found in surgical samples without prior diagnosis in 4 to 15% of the patients. In some of them, there is previous suspicion but in others this finding is completely incidental. We present 7 cases of prostate cancer detected in 100 patients who underwent bipolar transurethral resection (TUR) of the prostate due to regular indications. The aim of this paper is to describe patient's characteristics, postoperative outcome, analyze TURP as a diagnostic tool and evaluate therapeutic options for prostate cancer (PCa). METHODS One hundred patients with bladder outlet obstruction due to benign prostatic hyperplasia (BPH) underwent TURP in FUCDIM between June 2007 and August 2009. In 7 of them, prostate adenocarcinomas were detected. None of the patients underwent TURP only because of increased prostate-specific antigen (PSA). RESULTS Mean preoperative PSA was 7.6 ng/ml (r= 0.72 -27 ng/ml), 39% of the patients had PSA < 4 ng/ml; 33 (40%) had undergone previous biopsies and 36% of them had 2 or more previous biopsies. Prostate cancer detection global rate was 7%, 3 cases were incidental findings (low PSA and low-risk tumors), 3 patients had increased PSA and several previous biopsies with negative results and 1 had low PSA and aggressive tumor (Gleason 4+3). CONCLUSIONS TURP patients with prostate cancer are a heterogeneous group. TURP can be both diagnostic and therapeutic when facing patients with obstructive symptoms, high PSA and negative prostate biopsies. There are several therapeutic alternatives for TURP patients with cancer, taking into consideration tumor grade and stage, age, life expectancy and will of the patient. Bipolar TUR, in selected patients, allows to offer optional active surveillance (in these patients PSADT is very useful) and if cancer is not found, it eases the follow up of these patients. Active treatment (surgery or radiotherapy) is indicated in T1a patients with life expectancy longer than 10 years, and in the majority of T1b patients.