Recent studies presented at the World Congress of Endourology in Chicago may help to characterize the prevalence and clinical significance of prostate cancer (PCa) discovered incidentally as a result of surgical treatment for another medical problem.
In one study, Davis P. Viprakasit, MD, of Vanderbilt University in Nashville, and colleagues found incidental PCa in 20 (9.8%) of 204 men with no known history of PCa who underwent holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia. Nine patients were found to have PCa after HoLEP despite prior negative prostate biopsies or TURP. The other 11 patients with incidental PCa had relatively low preoperative PSA levels.
In addition, 11 patients with incidental PCa had a Gleason score of 6 or less, eight had a Gleason score of 7, and one had a Gleason score of 10, the researchers reported.
They pointed out that the diagnosis of incidental PCa is possible during HoLEP but not in other laser ablative procedures.
The study “underscores the importance of tissue diagnosis during laser treatments of BPH,” the authors concluded.
Also at the conference, researchers in Portugal reported finding incidental PCa in 10 (5.71%) of 186 patients who underwent transurethral resection of the prostate. The average Gleason score was 6 (range 4-8). Seven of the 10 patients had T1a disease and three had T1b disease. The investigators had follow-up data for nine of the 10 patients (mean 18.6 months). One patient underwent radical prostatectomy, one underwent radiotherapy. Two patients received androgen deprivation therapy and five were managed with active surveillance.
“Despite the systematic use of the PSA [test], incidental PCa is unavoidable, indicating that this screening method isn’t always accurate,” the researchers concluded.
In a separate study that included 102 men who underwent radical cystoprostatectomy for bladder cancer, British researchers found that 29 had concurrent PCa. The study, by
Fahim Ismail, MD, of Guy’s Hospital in London, and collaborators, also found that 11 of the 29 patients (38%) had a Gleason score higher than 6. Most of the concurrent prostate tumors were organ confined. Five patients had positive surgical margins. Forty-one of the 102 patients died. The mortality rate was 40% in men with and without concurrent PCa.
The finding of incidental prostate cancer appears not to affect the survival of patients following radical cystectomy, the authors concluded.
They noted that the finding of concurrent PCa in cystectomy specimens may reflect the population epidemiology of the malignancy.