Inapparent adenocarcinoma of the prostate-Study of 80 consecutive prostatectomies performed for clinically benign disease

ABSTRACT

Background and Inapparent prostate cancer in patients undergoing prostatectomy with a preoperative diagnosis of benign prostatic hyperplasia [BPH] was reported in between 10-24% of cases in the preprostate-specific antigen [PSA] era. With the increased use of PSA and a heightened awareness of prostatic cancer, we examined the incidence and characteristics of carcinoma diagnosed in patients undergoing prostatectomy for symptomatic BPH. Patients and 80 consecutive prostatectomies performed for symptomatic BPH were reviewed. All patients had undergone digital rectal and ultrasound examination. 65 patients had PSA measured and 15 did not. 43 patients had PSA between 0-4 ng/ml. 15 patients had PSA from 4.1-10 ng/ml, and 7 patients had PSA > 10 ng/ml. 9 patients underwent preoperative prostatic needle biopsy. All 9 biopsies were negative for carcinoma. 4/80 patients [5%] had adenocarcinoma on pathological examination. One patient had stage T[1b] and 3 patients had stage T[1b]. None of the patients with PSA <4 ng/ml had carcinoma. Two patients with PSA from 4-10 had carcinoma. One had stage T[1a] and the other stage T[1b]. Biopsy had not been done in these 2 patients. One specimen from a patient with PSA >10 ng/ml and a negative preoperative needle biopsy demonstrated stage T[1b] cancer of the prostate. One patient who did not have PSA measured preoperatively had T[1b] disease. The use of PSA and other techniques to diagnose prostate cancer prior to surgery for BPH have reduced the incidence of clinically inapparent cancer but have not eliminated it entirely. Significant numbers of cancers continue to be missed