Incidental Carcinoma of the Prostate in the PSA Era

Abstract

Background: Prostate cancer has classically been discovered in 10% of prostatectomy specimens from presumed benign disease. Our objective was to review incidental cancer in transurethral prostatectomy (TURP) specimens and to establish whether or not the incidence, presentation, and pathology have changed since the advent of prostate specific antigen (PSA). Methods: Five hundred and thirty patients underwent TURP for presumed benign disease at our institution in 1985 (before PSA), and 481 underwent TURP between 1994 and 1995. The charts of all patients with cancer were reviewed. Patients with known cancer preoperatively were excluded. Charts were reviewed with regard to indication for TURP, presentation, age, size of prostate, digital rectal exam, PSA, and pathology report. The most recent preoperative PSA value was utilized. Pathologic factors included the weight (grams resected), grade, and extent of tumors. Stage T1a tumors were defined as having Gleason scores of <6 and volumes of <5%. If the percentage of volume was not given, the specimen was considered to be Stage T1a if cancer was present in three chips or less. All other tumors were considered Stage T1b disease. Results: In 1985, Stage T1a cancer comprised 4% of specimens, and Stage T1b comprised 6%. In 1994 and 1995, Stage T1a cancer comprised 4%, but Stage T1b comprised 3%. This change in the incidence of T1b disease was statistically significant with a p value of 0.04. There was no difference with regard to patient age, specimen weight, or Gleason score. Urinary retention was a more common indication for TURP in 1994 and 1995. Conclusions: Our findings suggest that PSA screening has decreased the incidence of Stage T1b prostate cancer.