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Role of transition zone sampling by TURP in patients with raised PSA and multiple negative transrectal ultrasound-guided prostatic biopsies

Abstract

The purpose of the study was to determine the role of transurethral resection of the prostate (TURP) to detect prostate cancer in patients with consistently negative transrectal ultrasound-guided biopsies of the prostate. We retrospectively identified and analysed the patients who also had at least two sets of transrectal ultrasound guided sextant prostate biopsies before their TURP during the period between 1998 and 2002. A total of 14 such patients were identified and the outcome of TURP was analysed. Three patients were found to have cancer in the resected specimen (3/14=21%). All three cancers were significant (Gleason scores between 6 and 8) and required further treatment. In patients who have rising levels of prostate-specific antigen and who have had multiple negative peripheral zone biopsies, the presence of biologically important transition zone cancers needs to be considered. This can be detected by transurethral resection of the prostate that samples the transition zone of the prostate.

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References

  1. Partin AW, Oesterling JE . The clinical usefulness of prostate specific antigen: update 1994. J Urol 1994; 152: 1358.

    Article  CAS  Google Scholar 

  2. Catalona WJ et al. Comparison of digital rectal examination serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6,630 men. J Urol 1994; 151: 1283.

    Article  Google Scholar 

  3. Djavan B et al. Safety morbidity of first repeat transrectal ultrasound guided prostate needle biopsies: results of a prospective European prostate cancer detection study. J Urol 2001; 166: 856.

    Article  CAS  Google Scholar 

  4. Djavan B et al. Prospective evaluation of prostate cancer detected on biopsies 1, 2, 3 and 4: when should we stop? J urol 2001; 166: 1679.

    Article  CAS  Google Scholar 

  5. Durkan GC, Greene DR . Elevated serum prostate specific antigen levels in conjunction with an initial prostatic biopsy negative for carcinoma: who should undergo a repeat biopsy? Br J Urol Int 1999; 83: 34.

    Article  CAS  Google Scholar 

  6. McNeal JE, Redwine EA, Freiha FS, Stamey TA . Zonal distribution of prostatic adenocarcinoma: correlation with histologic pattern and direction of spread. Am J Surg Pathol 1988; 12: 897.

    Article  CAS  Google Scholar 

  7. Reissigl A et al. Frequency clinical significance of transition zone cancer in prostate cancer screening. Prostate 1997; 30: 130.

    Article  CAS  Google Scholar 

  8. Stamey TA, Dietrick DD, Issa MM . Large organ confined impalpable transition zone prostate cancer: association with metastatic levels of prostate specific antigen. J Urol 1993; 149: 510.

    Article  CAS  Google Scholar 

  9. Coplen DE, Andriole GL, Yuan JJJ, Catalona WJ . The ability of systematic transrectal ultrasound guided biopsy to detect prostate cancer in men with the clinical diagnosis of benign prostatic hyperplasia. J Urol 1991; 146: 75.

    Article  CAS  Google Scholar 

  10. Lee F et al. Prostate cancer: transrectal ultrasound pathology comparison. A preliminary study of outer gland (peripheral and central zones) and inner gland (transition zone) cancer. Cancer 1991; 67 (Suppl. 4): 1132.

    Article  CAS  Google Scholar 

  11. Hricak H . Advances in urologic imaging part 2: prostate and bladder imaging. Monogr. Urol 1990; 11: 69.

    Google Scholar 

  12. Chang JJ, Shinohara K, Bhargava V, Presti JC . Prospective evaluation of lateral biopsies of the peripheral zone for prostate cancer detection. J Urol 1998; 160: 2111.

    Article  CAS  Google Scholar 

  13. McNeal JE et al. Stage A vs Stage B adenocarcinoma of the prostate: morphological comparison biological significance. J Urol 1988; 139: 61.

    Article  CAS  Google Scholar 

  14. Ornstein DK, Rao GS, Smith DS, Andriole GL . The impact of systematic prostate biopsy on prostate cancer incidence in men with symptomatic benign prostatic hyperplasia undergoing transurethral resection of the prostate. J Urol 1997; 157: 880.

    Article  CAS  Google Scholar 

  15. Kitamura H et al. Does transurethral resection of the prostate facilitate detection of clinically significant prostate cancer that is missed with systematic sextant transition zone biopsies. Int J Urol 2002; 9: 95.

    Article  Google Scholar 

  16. Zigeuner R et al. Detection of prostate cancer by TURP or open surgery in patients with previously negative transrectal prostate biopsies. Urology 2003; 62: 883.

    Article  Google Scholar 

  17. Lui PD, Terris MK, McNeal JE, Stamey TA . Indications for ultrasound guided transition zone biopsies in the detection of prostate cancer. J Urol 1995; 153: 1000.

    Article  CAS  Google Scholar 

  18. Bazinet M et al. Value of systematic transition zone biopsies in the early detection of prostate cancer. J Urol Feb 1996; 155: 605.

    Article  CAS  Google Scholar 

  19. Terris MK, Pham TQ, Issa MM, Kabalin JN . Routine transition zone seminal vesicle biopsies in all patients undergoing transrectal ultrasound guided prostate biopsies are not indicated. J Urol 1997; 157: 204.

    Article  CAS  Google Scholar 

  20. Durkan G, Sheik N, Hildreth AJ, Greene DR . Diagnostic yield of extended core biopsies of the lateral peripheral zone transition zone in the detection of prostate cancer. J Urol 2000; 163 (Suppl): 275.

    Google Scholar 

  21. Greene DR et al. A comparison of the morphological features of cancer arising in the transition zone in the peripheral zone of the prostate. J Urol 1991; 146: 1069.

    Article  CAS  Google Scholar 

  22. Epstein JI, Paull G, Eggleston JC, Walsh PC . Prognosis of untreated stage A1 prostatic carcinoma: a study of 94 cases with extended follow up. J Urol 1986; 136: 837.

    Article  CAS  Google Scholar 

  23. Neal DE, Habib F, Hargreave T . The National Prostatectomy Audit. Br J Urol 1997; 79: 69.

    Article  Google Scholar 

  24. Rovner ES, Schanne FJ, Malkowicz SB, Wein AJ . Transurethral biopsy of the prostate for persistently elevated or increasing prostate specific antigen following multiple negative transrectal biopsies. J Urol 1997; 158: 138.

    Article  CAS  Google Scholar 

  25. Bales GT et al. Role of transurethral biopsy sampling of the prostate to diagnose prostate cancer in men undergoing surgical intervention for benign prostatic hyperplasia. Tech Urol 2000; 6: 201.

    CAS  PubMed  Google Scholar 

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Acknowledgements

We thank Sue Asterling—research nurse in helping with data collection.

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Correspondence to S Radhakrishnan.

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Radhakrishnan, S., Dorkin, T., Sheikh, N. et al. Role of transition zone sampling by TURP in patients with raised PSA and multiple negative transrectal ultrasound-guided prostatic biopsies. Prostate Cancer Prostatic Dis 7, 338–342 (2004). https://doi.org/10.1038/sj.pcan.4500756

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