title: Did the rate of incidental prostate cancer change in the era of PSA testing? A retrospective study of 1127 patients.
abstract: OBJECTIVE
  To evaluate, in a retrospective study, the impact of routine prostate-specific antigen (PSA) testing on the rate of incidental prostate cancer in patients undergoing surgery for obstructive symptoms caused by presumed benign prostatic enlargement (BPE) and to investigate the indication of a routine biopsy before alternative treatment procedures for BPE. In the pre-PSA era, the diagnosis of incidental carcinoma was exclusively based on normal digital rectal examination (DRE) findings.
  
  
  METHODS
  Since January 1993, 2422 operations (2283 transurethral resection of the prostate, 139 retropubic adenoma enucleations) for BPE were performed at our institution. The preoperative DRE findings and PSA level were evaluated, and patients with any suspicion for cancer were excluded. The pathologic reports of all patients were reviewed. A diagnosis of incidental carcinoma of the prostate required histologic evidence of cancer and negative DRE findings and a PSA level within age-specific reference ranges preoperatively.
  
  
  RESULTS
  Of 2422 patients, 1127 (46.5%) had both negative DRE findings and an age-specific PSA level and were evaluated for our study. Overall, prostate cancer was diagnosed by surgery in 314 (13%) of 2422 patients. The rate of incidental prostate cancer in patients with both negative age-specific PSA levels and negative DRE findings was 6.4% (72 of 1127).
  
  
  CONCLUSIONS
  In our series, the likelihood of detecting incidental prostate cancer by surgery was 6.4%. In the PSA era, the rate of incidental prostate cancer has been decreased by more than 50%. Today, the low rate of incidental carcinoma does not warrant routine histologic evaluation of the prostate if PSA testing and DRE are negative when alternative treatment modalities without tissue sampling are offered for the treatment of BPE.
authors.affiliation: Department of Urology, University Hospital, Karl Franzens University Graz, Graz, Austria.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Zigeuner
authors.forename: Katja
authors.initials: K
authors.lastname: Lipsky
authors.forename: Ildikò
authors.initials: I
authors.lastname: Riedler
authors.forename: Marco
authors.initials: M
authors.lastname: Auprich
authors.forename: Luigi
authors.initials: L
authors.lastname: Schips
authors.forename: Michael
authors.initials: M
authors.lastname: Salfellner
authors.forename: Karl
authors.initials: K
authors.lastname: Pummer
authors.forename: Gerhart
authors.initials: G
authors.lastname: Hubmer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria / Q000453:epidemiology; D001706:Biopsy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D010173:Palpation; D011300:Preoperative Care; D017430:Prostate-Specific Antigen / Q000032:analysis; D011470:Prostatic Hyperplasia / Q000601:surgery; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate
chemical_list: D017430:Prostate-Specific Antigen