Survival after incidental prostate cancer diagnosis at transurethral resection of prostate: 10-year outcomes

Ir J Med Sci. 2012 Mar;181(1):27-31. doi: 10.1007/s11845-011-0753-x. Epub 2011 Sep 11.

Abstract

Background: The most appropriate management of incidental prostate cancers diagnosed at transurethral resection of prostate has been debated. It is important to determine the long-term outcomes to establish an appropriate management in patients with incidental prostate cancer.

Aims: We aim to determine 10-year survival and to identify the factors of worse prognosis of incidental prostate cancers diagnosed at transurethral resection of prostate.

Methods: A retrospective analysis of patients with pT1a-pT1b prostate cancers diagnosed between 1998 and 2003. Medical notes, PSA and pathology results were reviewed. Overall and cancer specific survival was calculated at mean 10-year follow-up.

Results: Sixty patients with incidental prostate cancer were identified (pT1a = 18, pT1b = 42). Fifty-one percents of the patients were managed on a watchful waiting strategy with overall 84% survival and 9.7% cancer specific mortality. Twenty patients (all with pT1b) received hormone therapy. Overall survival in this cohort was 50% with 20% cancer specific mortality. Nine patients received curative therapy (Radical prostatectomy = 4, Radiotherapy = 5). In this group, overall survival was 88% with no cancer specific mortality.

Conclusions: Stage pT1a disease and preoperative low PSA were associated with favourable survival. However, for pT1b and/or high Gleason score (≥7), mortality was comparatively higher. Hence, patients with high Gleason score and/or pT1b disease should be considered for curative therapy. Additionally, active surveillance may have a role in selected men with incidental prostate cancer.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents, Hormonal / therapeutic use
  • Humans
  • Incidental Findings
  • Male
  • Middle Aged
  • Prostatectomy*
  • Prostatic Neoplasms / diagnosis*
  • Prostatic Neoplasms / pathology
  • Prostatic Neoplasms / therapy*
  • Prostatism / surgery
  • Radiotherapy
  • Survival Analysis
  • Watchful Waiting

Substances

  • Antineoplastic Agents, Hormonal