Ganime ÇOBAN, Pelin YILDIZ, Cevper ERSÖZ, Muzaffer AKÇAY, Bayram DOĞAN, Abdullah İLKTAÇ, Habib AKBULUT

Benign prostat hiperplazisinin cerrahi tedavisi sonrası tanı konulan insidental prostat kanseri

Amaç: İnsidental prostat kanseri (PCa) klinik belirti vermeyen, ameliyat öncesi rektal tuşe, prostat spesifik antijen (PSA) ve görüntülemeleri normal hastalarda transüretral prostat rezeksiyonu (TURP) veya açık prostatektomi sonrası tespit edilen kanser olarak tanımlanır. Bu çalışmanın amacı kliniğimizdeki insidental PCa insidansını ve klinik anlamlılığını belirlemektir.Gereç ve Yöntemler: Merkezimizde 2014-2019 yılları arasında benign prostat hiperplazisi ön tanısı ile TURP veya transvezikal prostatektomi (TVP) uygulanan 1020 hasta retrospektif olarak incelendi. Hastanın yaşı, prostat hacmi, preoperatif PSA değeri, Gleason skoru, ISUP skoru, evresi ve ameliyat öncesi prostat biyopsisinin varlığı not edildi. Prostat kanseri için uygulanan tedavi yöntemleri değerlendirildi.Bulgular: Ocak 2014 ile Aralık 2019 arasında toplam 1020 hasta BPH için cerrahi olarak tedavi edildi. 57 (%5.6) hastaya insidental PCa tanısı kondu. Hastaların 51’i (% 89) TURP ve 6’sı (%11) TVP olmuştu. Ortalama yaş 69.9±7.1 yıl ve ortalama PSA değeri 5.3±4.8 ng/ml idi. Hastaların çoğunluğu (%82.4) Gleason skor 6 (3+3) ve 37’si (%64.9) evre 1a olarak rapor edildi. Preoperatif prostat biyopsisi yapılan hastaların prostat hacmi ve PSA değerleri biyopsi yapılmayanlara göre anlamlı olarak daha yüksekti (p<0.01). Toplam 42 hastada aktif izlem yapıldı, 2 hastaya radikal prostatektomi, 6 hastaya radyoterapi ve 7 hastaya androjen blokajı uygulandı. Sonuç: Kliniğimizdeki insidental PCa oranı literatürde bildirilen oranlara benzer bulunmuştur. Hastaların çoğunda evre 1a hastalık ve Gleason 6 skoru tespit edilmiştir. İnsidental prostat kanserinin tedavisinde konservatif tedavi seçenekleri ön planda yer almaktadır.Anahtar Kelimeler: insidental prostat kanseri, benign prostat hiperplazisi, transüretral prostat rezeksiyonu.

Anahtar Kelimeler:

insidental prostat kanseri, benign prostat hiperplazisi, transüretral prostat rezeksiyonu

Incidental prostate cancer diagnosed after surgical treatment of benign prostatic hyperplasia

Objective: Incidental prostate cancer (PCa) is defined as the clinically inapparent tumor detected after transurethral resection of prostate (TURP) or open prostatectomy with benign preoperative rectal examination, prostate specific antigen (PSA) and imaging. The aim of this study is to determine the incidence and clinical significance of incidental prostate cancer in our clinic.Material and Methods: A retrospective analysis was performed in patients who were treated with TURP or transvesical open prostatectomy (TVP) between January 2014 and December 2019. Age, prostate volume, preoperative PSA value, Gleason score, ISUP score, stage and presence of previous prostate biopsy were noted. Treatment performed for incidental PCA was determined.Results: A total of 1020 patients were surgically treated for benign prostate hyperplasia between January 2014 and December 2019. Incidental PCa was diagnosed in 57 (5.6%) patients. 51 (89%) of the patients had TURP and 6 (11%) had TVP. Mean age was 69.9±7.1 years and mean PSA value was 5.3±4.8 ng/ml. Majority of the patients (82.4%) had a Gleason score of 6 (3+3) and 37 (64.9%) patients were reported as stage 1a. Patients with preoperative prostate biopsy have significantly higher prostate volume and PSA values compared to the patients without biopsy (p<0.01). Active surveillance was performed in 42 patients, 2 patients underwent radical prostatectomy, 6 patients had radiotherapy and 7 patients had androgen blockade.Conclusion: We have an incidental PCa rate similar to the literature. Majority of the patients have stage 1a disease and a Gleason score of 6. Most of the patients were managed conservatively.

Keywords:

incidental prostate cancer, benign prostate hyperplasia, transurethral resection of prostate,

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