Transurethral Resection Of The Prostate Role In Patients With Elevated PSA Level, Minor Lower Urinary Tract Symptoms, And Bladder Outlet Obstruction

UroToday.com - In the online edition of European Urology, Dr. Koenraad van Renterghem and associates presented their data on how to manage patients with an elevated PSA and proven bladder outlet obstruction. Between 2005 and 2007, 33 consecutive men with an elevated PSA, a negative prostate biopsy, minor LUTS (IPSS 0-19), and with urodynamics evidence of bladder outlet obstruction all underwent a transurethral resection of the prostate (TURP).

The mean patient age was 66.6 years and the mean PSA level before TURP was 8.2ng/ml. They divided the patients into:

Group 1: Only histologic BPH on TURP
Group 2: Aggressive CaP
Group 3: Non-aggressive CaP and/or BPH.

Pre-TURP levels before surgery were similar. The mean IPSS before TURP was 6.8. On urodynamics, the mean PdetQmax in all patients was 80.3cm H2O.

After the TURP, 27 men (81.8%) were found to only have histologic BPH. Two men (6.1%) had Gleason scores 8 and 6 (large volume) CaP and were labeled as aggressive CaP (T1b). Both underwent radical prostatectomy three months later. The four other patients (12.1%) had a small amount of CaP (stage T1a).

The mean PSA value after TURP was 0.6ng/ml and was the same in groups 1 and 3. Six months after TURP, mean IPSS in groups 1 and 3 were 2.5 and 2.4, respectively. Quality of life in group 1 improved from 1.8 before the TURP to 0.7 and in group 3 it improved from 1.7 to 0.6. Seven of the men from group 3 had a postoperative urodynamics evaluation and the mean PdetQmax post-TURP was 16.4cm H2O.

The study suggests that this approach for patients with mild LUTS and an elevated PSA has good outcomes. However, medical management for the LUTS, with continued biopsies as indicated, would be another approach to this problem.

van Renterghem K, Van Koeveringe G, Achten R, van Kerrebroeck P
Eur Urol. 2008 Jun 26. Epub ahead of print.
doi:10.1016/j.eururo.2008.06.069

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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