Copenhagen Prostate Cancer Center, Department of Urology, Center for Cancer and Organ Disease, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Cancer. 2022 Oct;128(20):3674-3680. doi: 10.1002/cncr.34407. Epub 2022 Aug 17.
The oncological risks after benign histology on a transurethral resection of the prostate (TURP) remain largely unknown. Here, the risk of prostate cancer incidence and mortality following a benign histological assessment of TURP is investigated in a population-based setting.
Between 1995 and 2016, 64,059 men in Denmark underwent TURP without prior biopsy of the prostate; 42,558 of these men had benign histology. The risks of prostate cancer, prostate cancer with a Gleason score ≥ 3 + 4, and prostate cancer-specific death were assessed with competing risks. Specific risks for pre-TURP prostate-specific antigen (PSA) levels at 10 and 15 years were visualized by locally estimated scatterplot smoothing.
The median age at TURP was 72 years (interquartile range [IQR], 65-78 years), and the median follow-up was 15 years (IQR, 10-19 years). The 10-year risks of any prostate cancer and prostate cancer with a Gleason score ≥ 3 + 4 and the 15-year risk of prostate cancer death showed clear visual relations with increasing PSA. The 15-year cumulative incidence of prostate cancer-specific death after benign TURP was 1.4% (95% confidence interval [CI], 1.3%-1.6%) for all men and 0.8% (95% CI, 0.6%-1.1%) for men with PSA levels <10 ng/ml. The primary limitation was exclusion due to missing PSA data.
Men with low PSA levels and a benign TURP can be reassured about their cancer risk and do not need to be monitored differently than any other men. Patients with high PSA levels can be considered for further follow-up with prostate magnetic resonance imaging. These findings add to the literature suggesting that normal histology from the prostate entails a low risk of death from the disease.
There is little knowledge about the oncological risks after the surgical treatment of benign prostatic hyperplasia. This study shows a very low risk of adverse oncological outcomes in men with prostate-specific antigen (PSA) levels below 10 ng/ml at the time of transurethral resection of the prostate. Patients with higher PSA levels may need more extensive follow-up.
经尿道前列腺切除术（TURP）后的肿瘤学风险在很大程度上仍不清楚。在此，在基于人群的环境中，研究 TURP 良性组织学评估后前列腺癌发病和死亡的风险。
1995 年至 2016 年间，丹麦有 64059 名男性接受了 TURP 治疗，而此前未对前列腺进行活检；其中 42558 名男性的组织学检查结果为良性。使用竞争风险评估前列腺癌、Gleason 评分≥3+4 的前列腺癌和前列腺癌特异性死亡的风险。通过局部估计散点平滑图可视化术前前列腺特异性抗原（PSA）水平在 10 年和 15 年的特定风险。
TURP 的中位年龄为 72 岁（四分位距 [IQR]，65-78 岁），中位随访时间为 15 年（IQR，10-19 年）。10 年任何前列腺癌和 Gleason 评分≥3+4 的前列腺癌以及 15 年前列腺癌死亡的风险与 PSA 的增加呈明显的视觉关系。在所有男性中，良性 TURP 后 15 年前列腺癌特异性死亡的累积发生率为 1.4%（95%CI，1.3%-1.6%），PSA<10ng/ml 的男性为 0.8%（95%CI，0.6%-1.1%）。主要的局限性在于由于 PSA 数据缺失而被排除。
PSA 水平较低且 TURP 为良性的男性可以对其癌症风险感到放心，并且不需要与其他男性进行不同的监测。PSA 水平较高的患者可以考虑进一步进行前列腺磁共振成像检查。这些发现增加了文献中的证据，表明前列腺的正常组织学意味着死于该疾病的风险较低。
关于良性前列腺增生症的治疗后肿瘤学风险知之甚少。本研究表明，在 TURP 时 PSA 水平低于 10ng/ml 的男性发生不良肿瘤学结果的风险非常低。PSA 水平较高的患者可能需要更广泛的随访。
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