Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
Division of Experimental Oncology, Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
J Urol. 2024 Nov;212(5):692-700. doi: 10.1097/JU.0000000000004159. Epub 2024 Jul 31.
Approximately 1 in 10 patients without prior prostate biopsy undergoing surgery for lower urinary tract symptoms harbors incidental prostate cancer; however, practice guidelines do not provide recommendations for its management. We aimed at describing the oncologic outcomes of patients with Grade Group (GG) 1 and GG2 prostate cancer diagnosed at transurethral resection of the prostate (TURP).
This was a nationwide, population-based, observational study of patients undergoing TURP in Denmark from 2006 to 2022 using the Danish Prostate Registry. We estimated the cumulative incidence of further biopsies and MRI, curative treatment, endocrine treatment, and cause-specific mortality with competing risk analyses.
Among 24,494 patients who underwent TURP, there were 1016 men with GG1 and 381 with GG2 prostate cancer. The 5-year cumulative incidence of further MRIs or biopsies was 36% (95% CI 33%-39%) for GG1 and 30% (95% CI 25%-34%) for GG2 disease. Fifteen-year prostate cancer mortality was 8.4% (95% CI 5.3%-11%) for GG1 and 14% (7.5%-21%) for GG2. A total of 270 men with GG1 disease underwent a biopsy after the TURP, and 162 (60%) had no cancer; in this group, prostate cancer mortality after 15 years was 0.6% (95% CI 0%-1.8%). Men with post-TURP biopsy ≥ GG2 had a prostate cancer mortality of 30% (95% CI 9%-50%) 15 years post TURP. The major limitation was the heterogeneous follow-up, which could lead to an overestimation of prostate cancer mortality compared to a more standardized follow-up.
We observed high prostate cancer mortality after TURP with GG1 or GG2, likely due to unsampled high-grade cancer in the peripheral zone. Patients with incidental prostate cancer should be further investigated to rule out high-grade cancer. For patients with GG1 on TURP, once a subsequent biopsy does not show cancer, follow-up should be lessened similar to that of patients with an initial nonmalignant biopsy.
大约每 10 名接受下尿路症状手术的无前列腺活检史的患者中，就有 1 人偶然患有前列腺癌；然而，临床实践指南并未对此类疾病的管理提供建议。我们旨在描述经尿道前列腺切除术（TURP）诊断的 GG1 和 GG2 前列腺癌患者的肿瘤学结局。
这是一项在丹麦进行的全国性、基于人群的、观察性研究，使用丹麦前列腺登记处，研究对象为 2006 年至 2022 年期间接受 TURP 的患者。我们采用竞争风险分析估计进一步活检和 MRI、治愈性治疗、内分泌治疗和特定原因死亡率的累积发生率。
在 24494 例接受 TURP 的患者中，有 1016 例为 GG1 前列腺癌患者，381 例为 GG2 前列腺癌患者。GG1 疾病的 5 年累积 MRI 或活检率为 36%（95%CI 33%-39%），GG2 疾病为 30%（95%CI 25%-34%）。GG1 前列腺癌的 15 年死亡率为 8.4%（95%CI 5.3%-11%），GG2 为 14%（7.5%-21%）。共有 270 例 GG1 疾病患者在 TURP 后接受了活检，其中 162 例（60%）未发现癌症；在该组中，15 年后的前列腺癌死亡率为 0.6%（95%CI 0%-1.8%）。在 TURP 后进行活检的 GG2 以上患者，15 年后的前列腺癌死亡率为 30%（95%CI 9%-50%）。主要局限性在于随访的异质性，这可能导致前列腺癌死亡率的高估，与更标准化的随访相比。
我们观察到 TURP 后 GG1 或 GG2 前列腺癌的死亡率较高，可能是由于外周带未取样的高级别癌症。偶然发现的前列腺癌患者应进一步检查，以排除高级别癌症。对于 TURP 后的 GG1 患者，一旦后续活检未发现癌症，应减少随访，类似于初始非恶性活检的患者。
