Men who have low prostate specific antigen (PSA) levels and undergo a benign transurethral resection of the prostate (TURP) can be monitored similarly to any other man, according to data from a study published in Cancer.
“TURP is the preferred surgical treatment option for men with lower urinary tract syndrome (LUTS) and bladder outlet obstructions due to benign prostatic hyperplasia,” study researchers wrote. However, the value of a benign TURP for excluding a prostate cancer diagnosis is controversial.
In this study, the researchers wanted to evaluate the probability of prostate cancer incidence and death after TURP in previously unbiopsied men in the Danish population. The study included 64,059 men in Denmark that underwent TURP from 1995 to 2016; 42,558 had benign histology. Subsequent histology after a benign initial TURP was available for 6,685 men: 1,986 were diagnosed with prostate cancer.
The median follow-up was 15 years. The 10-year risks of any prostate cancer and prostate cancer with a Gleason score of ≥3+4 and the 15-year risk of prostate cancer death had clear “visual relations” with increasing PSA, the study found.
The 15-year cumulative incidence of prostate cancer-specific death after benign TURP was 1.4% for all men and 0.8% for men with PSA levels <10 ng/mL. There was no clear relationship with age and prostate cancer-specific mortality in men with low PSA levels and benign initial TURP.
Our data show that the risk of prostate cancer-specific death is almost identical to the risk of prostate cancer-specific death in men with benign systematic TRUS biopsies,” the researchers wrote. “Hence, absent red flags such as a high PSA level, men with benign histology after TURP can be reassured that, despite a limited sampling of the prostate, they are at very low risk of aggressive prostate cancer and do not require extensive monitoring.”