Department of Urology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea.
Prostate Int. 2014 Dec;2(4):196-202. doi: 10.12954/PI.14060. Epub 2014 Dec 30.
The aim of this study was to define the clinical significance of transurethral resection of the prostate (TURP) in patients with benign prostate hyperplasia (BPH) and an elevated prostate-specific antigen (PSA) level.
We retrospectively evaluated patients with BPH, lower urinary tract symptoms (LUTS; International Prostate Symptom Score [IPSS]≥8), an elevated serum PSA level (≥4 ng/mL), and previous negative transrectal ultrasonography (TRUS) guided prostate biopsy. The PSA level after TURP was monitored by long-term follow-up. The tumor detection rate on resected prostate tissue, IPSS, maximal urinary flow rate (Qmax), and postvoid residual urine (PVR) were analyzed.
One-hundred and eighty-six patients were enrolled. Histological examination of resected tissue by TURP revealed prostate cancer in 12 of these patients (6.5%). Among 174 patients without prostate cancer, the mean PSA level and the PSA normalization rate in 112 patients followed up at postoperative day (POD) 3 months were 1.26±0.13 ng/mL and 94.6%, respectively. The mean PSA level and the PSA normalization rate were 1.28±1.01 ng/mL and 95.7% in 47 patients at 1st year, 1.17±0.82 ng/mL and 97.1% in 34 patients at second years, and 1.34±1.44 ng/mL and 97.2% in 36 patients at third years of TURP. One patient showed a dramatic increase in the PSA level was diagnosed with prostate cancer at 7 years after TURP. IPSS, quality of life, Qmax, and PVR were improved significantly at POD 3 months compared to baseline (P<0.05), respectively.
TURP significantly reduced the serum PSA level, which was maintained for at least 3 years. This could be helpful to screen the prostate cancer using PSA value in the patient with previous negative biopsy and elevated PSA. In addition, TURP improves IPSS, Qmax, and PVR in patients with BPH, moderate LUTS, and an elevated PSA level.
本研究旨在定义经尿道前列腺切除术（TURP）在前列腺特异性抗原（PSA）水平升高的良性前列腺增生（BPH）患者中的临床意义。
我们回顾性评估了 BPH、下尿路症状（LUTS；国际前列腺症状评分[IPSS]≥8）、血清 PSA 水平升高（≥4ng/ml）和先前经直肠超声（TRUS）引导前列腺活检阴性的患者。通过长期随访监测 TURP 后的 PSA 水平。分析切除前列腺组织的肿瘤检出率、IPSS、最大尿流率（Qmax）和残余尿量（PVR）。
共纳入 186 例患者。TURP 切除组织的组织学检查显示 12 例（6.5%）患者患有前列腺癌。在 174 例无前列腺癌的患者中，112 例患者在术后第 3 个月的平均 PSA 水平和 PSA 正常化率分别为 1.26±0.13ng/ml 和 94.6%。47 例患者在第 1 年的平均 PSA 水平和 PSA 正常化率分别为 1.28±1.01ng/ml 和 95.7%，34 例患者在第 2 年的平均 PSA 水平和 PSA 正常化率分别为 1.17±0.82ng/ml 和 97.1%，36 例患者在第 3 年的平均 PSA 水平和 PSA 正常化率分别为 1.34±1.44ng/ml 和 97.2%。1 例 TURP 后 7 年 PSA 水平显著升高的患者被诊断为前列腺癌。与基线相比，术后第 3 个月 IPSS、生活质量、Qmax 和 PVR 均显著改善（P<0.05）。
TURP 可显著降低 PSA 水平，至少可维持 3 年。这有助于在先前经活检和 PSA 水平升高的患者中使用 PSA 值筛查前列腺癌。此外，TURP 可改善 BPH、中度 LUTS 和 PSA 水平升高患者的 IPSS、Qmax 和 PVR。
