Frequency of carcinoma of prostate in clinically benign prostatic hyperplasia and role of different screening tests

ABSTRACT

To assess the frequency of carcinoma in clinically benign prostatic hyperplasia and role of digital rectal examination [DRE] and prostatic specific antigen [PSA] in assessment of these patients. Patients admitted to the Department of Urology and Renal Transplantation with lower urinary tract symptoms [LUTS] due to enlarged prostate. Descriptive Study. Department of Urology and Renal Transplantation, Quaid-I-Azam Medical College /Bahawal Victoria Hospital, Bahawalpur, from January 2007 to December 2010. Patients presenting with lower urinary tract symptoms over the age of 50 years were evaluated on International Prostate Symptoms Score [IPSS], clinically examined and post-voiding residual urine determined on abdominal ultrasonography. The selection criteria were; Refractory retention of urine, Severe IPSS, absence of signs of malignancy on Digital Rectal Examination [DRE] and post-voiding residual urine more than 100 ml. Thus a total 300 patients were selected. Patient's blood sample was sent to laboratory to assess Prostate Specific Antigen [PSA] level pre-operatively. All these patients underwent either transurethral resection of prostate [TURP] or transvesical prostatectomy [TVP] and prostatic tissue was sent for histopathology. In this study, 13.33% patients were found to have carcinoma of prostate inspite of being clinically benign prostates in all patients, irrespective of PSA range. The PSA value was found < 4ng/ml in 211 [20.33%] patients and remaining 89 [29.67%] patients had PSA value > 4ng/ml. In this study, 9.95% patients had carcinoma prostate inspite having normal PSA and benign prostate on DRE while with rising PSA levels and normal DRE, chances of malignancy detection increases [66.67%]. We conclude that although frequency is low the possibility of malignancy in clinically benign enlarged prostate should be borne in mind whenever subjecting the patient for screening, assessment and treatment. DRE alone is insufficient to detect malignancy. PSA in combination with DRE is beneficial in predicting prevalence of carcinoma prostate.