[Prevalence of incidental prostatic adenocarcinoma after suprapubic adenomectomy with or without previous prostatic biopsy]. / Prevalencia de adenocarcinoma prostático incidental tras adenomectomía suprapúbica con o sin biopsia prostática previa.

OBJECTIVES: To establish the prevalence of incidental prostate cancer after transrectal ultrasound guided prostatic biopsy and subsequent suprapubic prostatic adenomectomy and to compare it with a similar group of patients who did not underwent biopsy before surgery. To evaluate treatment, outcomes, and disease progression in patients with incidental prostate cancer. METHODS: Retrospective study of 549 suprapubic adenomectomy performed between 1996-2001 (6 yr.), comparing the group of patients with biopsies before surgery vs. the group of patients without biopsies. RESULTS: 291 (53%) patients did not undergo biopsy before adenomectomy. 258 (47%) underwent biopsies. 25 incidental prostate cancers were detected, 19 (76%) in the group of no biopsy and 6 (24%) in the biopsy group. 88% pT1a and 12%pT1b. Mean Gleason score 4.5 (3-7). 84% of the patients did not receive treatment (21) ("wait and see"); 8% (2) androgen blockade; 8% (2) finasteride (2). Three patients (12%) in the group of no biopsy had disease progression. Mean follow-up was 48.1 months (22-96). No case of cancer-specific mortality was detected. CONCLUSIONS: Global prevalence of incidental prostate cancer in our series of patients undergoing suprapubic prostatic adenomectomy was 4.55%. Prevalence was higher in the group of patients without previous biopsy (3.46%) than in the biopsy group (1.09%). Tumor progression was 12% and cancer specific survival 100% after a mean follow-up of 48.1 months (22-92). Previous prostatic biopsy in patients with suspicions digital rectal examination or elevated PSA diminishes the prevalence of incidental prostate cancer. Watchful waiting may be a valid option in some cases.

Prevalencia de adenocarcinoma prostático incidental tras adenomectomía suprapúbica con o sin biopsia prostátic previa / Prevalence of incidental prostatic adenocarcinoma after suprapubic adenomectomy with or without previous prostatic biopsy

OBJETIVO: Determinar la prevalencia de cáncer de próstata incidental tras biopsia prostática transrectal ecodirigida y posterior adenomectomía prostáticasuprapúbica, y compararlo con la prevalencia de un grupo similar de pacientes que no fueron biopsiados previamente a la cirugía. Evaluar el tratamiento, la evolucióny las progresiones de la enfermedad tumoral en los pacientes con cáncer de próstata incidental.MÉTODOS: Estudio retrospectivo de 549 adenomectomíassuprapúbicas realizadas entre 1996-2001 (6 años), comparando el grupo de pacientes biopsiados previamente a la adenomectomía con el grupo no biopsiado.RESULTADOS: 291 (53%) pacientes no fueron biopsiadospreviamente a la adenomectomía. 258 (47%) fueronbiopsiados. 25 cánceres de próstata incidentales detectados, 19 (76%) en el grupo de los no biopsiados y 6 (24%) en el de los biopsiados. 88% pT1a y 12% pT1b. Gleason medio 4,5 (3-7). No fueron tratados el 84% de los pacientes (21) (“esperar y ver”); bloqueo hormonal 8% (2); finasteride 8% (2). Progresaron 3 pacientes (12%), todos del grupo de los no tratados. Media de seguimiento de 48,1 meses (22-96). No se detectó ningún caso de mortalidad cáncer de próstata específico.CONCLUSIONES: La prevalencia global de cáncer de próstata incidental en nuestra serie en pacientes a los que se les realizo adenomectomía prostática suprapúbicafue del 4,55%. La prevalencia fue mayor en el grupo de pacientes no biopsiados previamente a la adenomectomía (3,46%) que en el grupo de los biopsiados(1,09%). La progresión tumoral fue del 12% y la supervivencia cáncer de próstata específica del 100% tras una media de seguimiento de 48,1 meses (22-92). La biopsia prostática previa a la adenomectomía en pacientescon tacto rectal sospechoso o PSA elevado disminuyela prevalencia de cáncer prostático incidental. El seguimiento expectante activo puede ser una actitud valida en determinados casos

OBJECTIVES: To establish the prevalence of incidental prostate cancer after transrectal ultrasound guided prostatic biopsy and subsequent suprapubic prostatic adenomectomy and to compare it with a similar group of patients who did not underwent biopsy before surgery. To evaluate treatment, outcomes, and disease progression in patients with incidental prostate cancer. METHODS: Retrospective study of 549 suprapubicadenomectomy performed between 1996-2001 (6 yr.), comparing the group of patients with biopsies before surgery vs. the group of patients without biopsies.RESULTS: 291 (53%) patients did not undergo biopsy before adenomectomy. 258 (47%) underwent biopsies. 25 incidental prostate cancers were detected, 19 (76%) in the group of no biopsy and 6 (24%) in the biopsy group. 88% pT1a and 12%pT1b. Mean Gleason score 4.5 (3-7). 84% of the patients did not receive treatment (21) (“wait and see”); 8% (2) androgen blockade; 8% (2) finasteride (2). Three patients (12%) in the group of no biopsy had disease progression. Mean follow-up was 48.1 months (22-96). No case of cancer-specific mortality was detected.CONCLUSIONS: Global prevalence of incidental prostate cancer in our series of patients undergoing suprapubic prostatic adenomectomy was 4.55%. Prevalence was higher in the group of patients without previous biopsy (3.46%) than in the biopsy group (1.09%). Tumorprogression was 12% and cancer specific survival 100% after a mean follow-up of 48.1 months (22-92).Previous prostatic biopsy in patients with suspicionsdigital rectal examination or elevated PSA diminishes the prevalence of incidental prostate cancer. Watchful waiting may be a valid option in some cases