medwireNews: Men with a benign biopsy following transurethral resection of the prostate (TURP) have a low risk for prostate cancer overall but may benefit from further investigation if their prostate-specific antigen (PSA) level is high, research suggests.
“Men with low PSA levels (<7.5 ng/mL) and a benign TURP can be reassured about their cancer risk and do not need to be monitored differently than any other men,” write Hein Vincent Stroomberg (Copenhagen Prostate Cancer Center, Denmark) and co-authors in Cancer.
They continue: “Patients with high PSA levels can be considered for advanced imaging techniques such as prostate [magnetic resonance imaging].”
The researchers investigated the oncologic risks after TURP in 64,059 men (median age 72 years) who underwent the procedure in Denmark between 1995 and 2016. Of these, 66.4% initially had benign histology.
During a median 15 years of follow-up, 1986 men with an initial benign TURP were diagnosed with prostate cancer, including 1465 with a Gleason score of 7 or higher at diagnosis.
Overall, the 10-year cumulative incidences of prostate cancer and prostate cancer with a Gleason score of 7 or higher were 14.8% and 2.9%, respectively.
In addition, the 15-year cumulative incidences of prostate cancer-specific mortality and death from other causes were 1.4% and 61.0%, respectively.
Just under a quarter (24%) of participants had PSA data available and the investigators observed that the rate of prostate cancer, prostate cancer with a Gleason score of 7 or higher, prostate cancer-specific death, and to a lesser extent death from other causes, increased with increasing PSA level.
Specifically, the 15-year cumulative incidence of prostate cancer-specific death after benign TURP was 1.4% overall compared with 0.8%, 4.2%, and 6.5% for men with PSA levels below 10 ng/mL, between 10 and 20 ng/mL, and above 20 ng/mL, respectively.
Among men with lower PSA levels, the 15-year risks for prostate cancer-specific death were 0.6%, 0.9%, 1.7%, and 2.6% for PSA levels of 2.5, 5.0, 7.5, and 10.0 ng/mL, respectively.
Stroomberg et al conclude that their “findings support the hypothesis that prostate tumors that are not easily identified on limited sampling of the prostate are unlikely to be aggressive, and they cast doubt on the value of the suggested use of targeted biopsy approaches in men without other indications for prostate cancer, such as men with asymptomatic, elevated PSA levels.”
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