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Presentation at the annual Meeting of Urological Association of Okinawa (May, 2004)
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TURPTURP
as diagnostic measure of as diagnostic measure of Prostate CancerProstate Cancer
Oral presentation at the Meeting of Okinawa Urologists (Naha-city, Japan, 2004)004)
Vladimir Startsev,Vladimir Startsev, M.D., Urology Department, Regional Oncological Hospital
St.-Petersburg, Russia
PurposePurpose
To determine whether evaluation of TURP To determine whether evaluation of TURP
could detect could detect prostate cancer prostate cancer
missed by routine missed by routine
US-GuidedUS-Guided sextant prostate biopsiessextant prostate biopsies
9898 patientspatients (median age 66,4 y.o.)
with LUTS with LUTS andand
tPSA tPSA levellevel 5-12 5-12 ng/mL
All persons underwent systematic
US-guided sextant
PZ - biopsiesPZ - biopsies
Our post-biopsy resultsOur post-biopsy results
Positive (+) specimensPositive (+) specimens
28 28 cases of
prostate cancer
Negative (-) Negative (-) specimensspecimens
70 70 cases
28.6%28.6% 71.4%71.4%
TURP to all patientsTURP to all patients
with with negative (-) specimens negative (-) specimens andand indications to relief indications to relief LUTS LUTS && BNO BNO (n=49)(n=49)
Prostate cancer
in 12 (24.5%)in 12 (24.5%) - organ-confined
- Gleason score < 5
- <10 % of resected tissue
4 - RRP,
8 – MAB (Zoladex+Androcur) +RBT
Follow-up 6 month Follow-up 6 month
of non - operated, of non - operated,
(-) specimens patients (-) specimens patients (n=21)(n=21)
tPSAtPSA level increase in 77 (33.3%33.3%) cases, 7 second US-G biopsies
Prostate Cancer in 4 (19.0%) cases( 4 RRP performed)
Summarized schemaSummarized schema98 US-Guided biopsies
28.6% 71.4%
TURP n=49 Medicine n=21
24.5%24.5%19.0%19.0%
1212
44
DiscussionDiscussion
Specificity of routine US-guided prostate Specificity of routine US-guided prostate
biopsy is not high enough, using this biopsy is not high enough, using this
procedure is not warranted for cancer procedure is not warranted for cancer
detection.detection.
DiscussionDiscussion
TURP can detect cancer also in TZ of the TURP can detect cancer also in TZ of the
prostate, while treating LUTS with BNO prostate, while treating LUTS with BNO
in patients with negative biopsy in patients with negative biopsy
specimens.specimens.
ConclusionConclusionss
TURP is necessary for TURP is necessary for all patients with all patients with
severe LUTS (BNO associated) severe LUTS (BNO associated)
and negative prostate biopsies.and negative prostate biopsies.
ConclusionConclusionss
Now we perform Now we perform octant (n=8 cores)octant (n=8 cores)
US-Guided prostate biopsies.US-Guided prostate biopsies.
Do all we must?Do all we must?
Thank you for attention!Thank you for attention!
St.-Petersburg, Russia, 2004
Vladimir Startsevhttp://www.urostar.ru