Centre Hospitalier de l'Université de Montréal
Incidental prostate cancer in transurethral resection of the prostate: A comparison of modern resection techniques
Samuel Jaquet1, Zaineb Ben Mefteh1, Kevin C. Zorn2, Naeem Bhojani2, Dominique Trudel1.
1Department of Pathology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada; 2Department of Urology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
Introduction: Modern surgical techniques for treatment of benign prostate hyperplasia (BPH) provide pathologists with new challenges in interpretation of transurethral resection of prostate (TURP) specimens. We sought to compare incidentally detected prostate cancer (PCa) rates in Holmium/Thulium/Greenlight laser enucleation (LEP), Greenlight photoselective vapo-resection (PVRP) and mono/bipolar TURP (mbTURP) for BPH lower urinary tract symptoms (LUTS).
Methods: We reviewed data from all TURP specimens received at our pathology department from 2016 to 2020 (n=1228), including age, pre/postoperative prostate-specific antigen levels (PSA), preoperative prostate volume (PV), indication, technique and pathologic reports. After patients with known or suspected PCa or with TURP indication other than LUTS were excluded, PCa rates were calculated.
Results: 976 specimens were included (664 mbTURP, 194 PVRP and 118 LEP). Mean age was 70.5, 68.3 and 69.3 respectively. PV were larger in LEP (mean=137.7 ml, p<0.0001) compared to PVRP (82.6 ml) and mbTURP (75.1 ml). Preoperative PSA levels were higher in LEP (median=4.9 ng/ml, p=0.025) compared with mbTURP (2.9 ng/ml) and PVRP (3.2 ng/ml). Resected volume/PV ratios were higher in LEP (mean=72.9%, p<0.0001) than mbTURP (29.8%) and PVRP (8.0%). 88 (9.9%) PCa were identified, with ISUP grade groups distributed as follows: 57 group 1 (64.8%), 3 group 2 (3.4%), 21 group 3 (23.9%), 2 group 4 (2.3%) and 5 group 5 (5.7%). Cancer involved more than 5% of the resected volume (cT1b) in 27 cases (30.7%). Incidental PCa was identified in 69 mbTURP (10.4%), 2 PVRP (1.0%) and 17 LEP (14.4%) specimens, which was significantly different (p<0.001).
Conclusion: Incidental PCa rates were significantly lower in patients who underwent PVRP than mbTURP and LEP likely related to the smaller resected volume. Vaporization technique in PVRP, yielding in lower resected volumes with important cauterization artifacts, could contribute to this difference.
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