Evaluation of Postoperative Pathology Results of TURP or Prostatectomy in Patients with Previous Negative Prostatic Biopsies and Elevated Prostate-Specific Antigen Level and Its Role in the Diagnosis of Prostate Cancer

In cases with previous negative biopsies and a persistently elevated prostate-specific antigen (PSA) level, one of the best method for the definitive diagnosis of prostate cancer is the use of transurethral resection of the prostate (TURP). Therefore, this study aimed to compare the pathology results after the biopsy of such patients with the results obtained from TURP or open prostatectomy. 

This cross-sectional descriptive study included 95 patients referred to Shahid Beheshti Hospital, Hamadan, Iran, during 2014-19. The participants were selected by a census with a mean age of 68.81±8.38 years with total PSA>3 ng/ml and benign primary biopsy. Following that, they underwent TURP surgery. Data were extracted from hospital archives and recorded in the designed checklist. The variables including age, total and free PSA amount, prostate volume, frequency of biopsy, and the results of TURP or prostatectomy were examined in this study. Student t-test and non-parametric test of Mann-Whitney were used to analyze the data (P< 0.05).

Out of 95 patients studied after TURP or prostatectomy, 4.2% (n=4) of the cases were reported with cancer, and 25% (n=1), 50% (n=2), as well as 25% (n=1) of the patients, had Gleason scores of 5, 6, and 9, respectively, all of which were reported in the initial BPH biopsy. There was no statistically significant difference between cancer and non-cancer groups in terms of age, serum PSA, and prostate volume (P>0.05).

In patients whose PSA levels persistently increase despite previous negative biopsies, the TURP or open prostatectomy method can be used to diagnose prostate cancer more accurately.