A study examined 98 patients who underwent prostate biopsies and TURP surgery to relieve lower urinary tract symptoms (LUTS). 28% of biopsies detected prostate cancer while TURP detected additional cancers in 24.5% of patients, showing biopsies can miss cancers. For patients with negative biopsies, follow up found 19% had cancer, further showing biopsies have limits. The study concludes that TURP should be performed for all patients with LUTS and negative biopsies to fully detect prostate cancer.

1. TURPTURP
as diagnostic measure ofas diagnostic measure of
Prostate CancerProstate Cancer
Oral presentation at the Meeting
of Okinawa Urologists (Naha-city, Japan, 2004)004)
Vladimir Startsev,Vladimir Startsev, M.D.,
Urology Department, Regional Oncological Hospital
St.-Petersburg, Russia

2. PurposePurpose
To determine whether evaluation of TURPTo determine whether evaluation of TURP
could detectcould detect prostate cancerprostate cancer
missed by routinemissed by routine
US-GuidedUS-Guided sextant prostate biopsiessextant prostate biopsies

3. 9898 patientspatients
(median age 66,4 y.o.)
with LUTSwith LUTS andand
tPSAtPSA levellevel 5-125-12 ng/mL
All persons underwent
systematic
US-guided sextant
PZ - biopsiesPZ - biopsies

4. Our post-biopsy resultsOur post-biopsy results
Positive (+)Positive (+)
specimensspecimens
2828 cases of
prostate cancer
Negative (-)Negative (-)
specimensspecimens
7070 cases
28.6%28.6% 71.4%71.4%

5. TURP to all patientsTURP to all patients
withwith negative (-) specimensnegative (-) specimens andand
indications to reliefindications to relief LUTSLUTS && BNOBNO (n=49)(n=49)

6. Prostate cancer
in 12 (24.5%)in 12 (24.5%)
- organ-confined
- Gleason score < 5
- <10 % of resected tissue
4 - RRP,
8 – MAB (Zoladex+Androcur) +RBT

7. Follow-up 6 monthFollow-up 6 month
of non - operated,of non - operated,
(-) specimens patients(-) specimens patients (n=21)(n=21)
tPSAtPSA level increase in 77 (33.3%33.3%) cases,
7 second US-G biopsies
Prostate Cancer in 4 (19.0%) cases
( 4 RRP performed)

8. Summarized schemaSummarized schema
98 US-Guided biopsies
28.6% 71.4%
TURP n=49 Medicine n=21
24.5%24.5%
19.0%19.0%
1212
44

9. DiscussionDiscussion
Specificity of routine US-guided prostateSpecificity of routine US-guided prostate
biopsy is not high enough, using thisbiopsy is not high enough, using this
procedure is not warranted for cancerprocedure is not warranted for cancer
detection.detection.

10. DiscussionDiscussion
 TURP can detect cancer also in TZ of theTURP can detect cancer also in TZ of the
prostate, while treating LUTS with BNOprostate, while treating LUTS with BNO
 in patients with negative biopsyin patients with negative biopsy
specimens.specimens.

11. ConclusionConclusionss
TURP is necessary forTURP is necessary for all patients withall patients with
severe LUTS (BNO associated)severe LUTS (BNO associated)
and negative prostate biopsies.and negative prostate biopsies.

12. ConclusionConclusionss
Now we performNow we perform octant (n=8 cores)octant (n=8 cores)
US-Guided prostate biopsies.US-Guided prostate biopsies.
Do all we must?Do all we must?

13. Thank you for attention!Thank you for attention!
St.-Petersburg,
Russia, 2004
Vladimir Startsev
http://www.urostar.ru