title: Does transurethral resection of the prostate facilitate detection of clinically significant prostate cancer that is missed with systematic sextant and transition zone biopsies?
abstract: BACKGROUND
  A prospective study was conducted to determine whether transurethral resection of the prostate (TURP) facilitates detection of prostate cancer that is missed with systematic sextant biopsies associated with transition zone (TZ) biopsies.
  
  
  METHODS
  A total of 139 consecutive patients underwent transperineal TZ biopsies of each lobe in addition to a transrectal systematic sextant peripheral zone (PZ) biopsy. Patients whose biopsies were negative for cancer received TURP for relief of lower urinary tract obstruction when indicated.
  
  
  RESULTS
  Cancer was detected in biopsy specimens of 40 patients. Of these cancers, 18 originated in the PZ alone and 22 were located both in the TZ and the PZ. No cancers were detected in the TZ alone. Of 99 patients who were proven not to have cancer by the biopsies, 18 were indicated for TURP. Five of these patients (28%) had cancer in the resected tissues. All cancers were clinically organ confined and their Gleason sum scores were 2-5. Cancer-positive chips accounted for less than 10% of all resected specimens. Of the 66 patients with negative biopsies and without indication for TURP, four (6%) were revealed to have an elevation of the serum PSA level during follow up. They were later proven to have cancer by a second biopsy.
  
  
  CONCLUSIONS
  Routine use of TZ biopsy is not warranted for detection of cancer. Transurethral resection of the prostate can detect cancers in patients with negative PZ and TZ biopsies. However, cancers detected by TURP may not always be clinically significant and only four of 66 patients who were not indicated for TURP and received a close follow up were later found to have cancer, although their follow-up period was short. Thus, it still remains to be elucidated whether TURP is necessary for all patients with negative biopsies of the prostate.
authors.affiliation: Department of Urology, Sapporo Medical University School of Medicine, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kitamura
authors.forename: Naoya
authors.initials: N
authors.lastname: Masumori
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Tanuma
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yanase
authors.forename: Naoki
authors.initials: N
authors.lastname: Itoh
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.forename: Taiji
authors.initials: T
authors.lastname: Tsukamoto
authors.forename: Hideki
authors.initials: H
authors.lastname: Adachi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hotta
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000032:analysis; D011471:Prostatic Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate
chemical_list: D017430:Prostate-Specific Antigen