A single center retrospective analysis of absolute and pseudo-incidental prostate cancer / 中华泌尿外科杂志

ABSTRACT

Objective:To analyze the clinical features of absolute incidental prostate cancer (AIPCa) and pseudo-incidental prostate cancer (PIPCa).Methods:Between January 2013 and October 2019, 52 male patients who were diagnosed as incidental prostate cancer (IPCa) with their postoperative pathological examination in our center were included. None of them had any evidence of prostate cancer before. Their median age was 77.5(ranging 55-93) years old. 48 cases underwent PSA examination. The median tPSA was 6.7 (ranging 1-46) ng/ml, except 1 case tPAS>100ng/ml. The median IPSS score was 27.7(ranging 12-35). 48 cases accepted prostatic ultrasound examination. The median prostate volume was 38.6 (ranging 2.3-130.2)ml. Among them, 13 patients underwent transurethral resection of the prostate (TURP), 24 patients underwent transurethral enucleation and resection of the prostate(TUERP), 15 patients underwent radical cystoprostatectomy(RCP). According to the patients′ preoperative examination, AIPCa and PIPCa were redefined. Clinical characteristics, postoperative pathology and follow-up of the two groups were compared and analyzed.Results:There was no significant difference in age, IPSS score, tPSA, T stage and Gleason score between the operation methods groups except for prostate volume and resection ration of prostate ( P>0.05). Among those group, the sequence of prostatic resection ration was RCP>TUERP>TURP( P<0.001). There was no significant difference in age, IPSS score, prostate volume, proportion of T 1b and Gleason score between AIPCa and PIPCa groups. However, the analysis showed higher tPSA(14.68 ng/ml vs. 3.14 ng/ml) in PIPCa ( P<0.001). With a mean follow-up of 33 months(ranging 6-78 months), 23.8%(5/21) patients in AIPCa group and 45.2%(14/31) patients in PIPCa group were found to have increased PSA and underwent radical prostatectomy or androgen deprivation therapy in the follow-up. There was no metastasis or death in AIPCa group, while 2 patients had bone metastasis and 1 patient died of prostate cancer in PIPCa group. Conclusions:According to the indication of prostate biopsy, PIPCa and AIPCa were defined. PIPCa has a relatively poor prognosis, some of them may be missed diagnosis and clinical underestimation. In order to avoid missed diagnosis before operation, we should strictly define IPCa and follow the indications of biopsy, emphasize the reference value of PSA in tumor screening and biopsy, and careful handle the negative results of biopsy when PSA is abnormal.