TURP Is Inferior for Prostate Cancer Detection

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In a recent study, transurethral resection of the prostate identified only 54% of prostate cancers.

Transurethral resection of the prostate (TURP) is effective for treating benign prostatic obstruction, but it is not reliable for detecting cancer, data show.

In a German study, researchers found that only 54% of prostate cancer cases were detected by TURP according to a report in Urology (2008; published online ahead of print).

Lead investigator Thorsten Bach, MD, of the Asklepios Clinic in Hamburg, said he was not surprised by this outcome because prostate cancer usually involves the peripheral zone of the prostate whereas TURP removes tissue from the core.

“Our belief that TURP is not an optimal tool to diagnose prostate cancer was confirmed by these results,” Dr. Bach concluded. “Patients who are at high risk for developing cancer—that is, those who have elevated PSA but negative results on previous biopsies—should be counselled to understand that negative histology from TURP does not give him 100% security. Close follow-up is mandatory in these patients.”

He added that he and his colleagues biopsy all patients with age-stratified PSA elevation.

J. Stephen Jones, MD, chairman of urology at the Cleveland Clinic's Glickman Urological & Kidney Institute in Cleveland, agreed with this interpretation of the results and with the benefits of biopsies.

“TURP carries more morbidity and less diagnostic accuracy than placing a biopsy needle into the same tissue,” Dr. Jones told Renal & Urology News. "We include transition zone tissue in every biopsy—not because we specifically target it, but because a biopsy that is performed properly will sample this tissue along the peripheral zone.”

Indeed, Dr. Jones's team published study findings in Prostate Cancer Prostatic Diseases (2008; published online ahead of print) showing a drastic drop in prostate cancer detection with TURP after the arrival of PSA screening.

Dr. Bach and his co-investigators retrospectively reviewed the charts of 84 patients with biopsy-proven prostate cancer who underwent TURP before primary high-intensity focused ultrasound therapy. Their mean age was 69.8 years and the mean prostate volume was 31.7 cm3. The mean PSA level was 9.8 ng/dL and the average amount of resected tissue was 17.9 g.

Prostate cancer had been detected in 45 of the 84 patients (54%). The investigators did not find any differences between patients who were negative or positive for cancer with respect to either PSA level or Gleason score.

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