Role of transurethral resection of the prostate and biopsy of the peripheral zone in the same session after repeated negative biopsies in the diagnosis of prostate cancer.
OBJECTIVE
To determine the role of the transurethral resection of the prostate (TURP) together with biopsies of the peripheral zone in the diagnosis of prostate cancer after repeated negative transrectal biopsies and increasing prostate-specific antigen (PSA) levels.


METHODS
From 2003 to 2004, 43 patients, aged 53-69 yr, were seen for a history of at least two negative biopsies for prostate cancer. Thirty-five men had an increasing PSA level and underwent another set of biopsies. Seven patients had prostate cancer (20%); three were lost at follow-up and four had a Charlson comorbidity index >1. The remaining 21 were offered TURP and biopsy of the peripheral zone. Bladder outlet obstruction had no influence on decision-making. Fourteen men accepted.


RESULTS
Eight patients (57%) had prostate cancer and underwent radical prostatectomy. Six cancers were detected only with TURP, one with TURP and biopsy, and one with biopsy alone. After a median of 9 mo of follow-up, two of six patients underwent rebiopsy for a rising PSA level, but no cancer was detected.


CONCLUSIONS
TURP combined with a set of transrectal needle biopsies of the lateral portion of the gland is a safe procedure with a high diagnostic power after repeated negative biopsies in patients with persistently increasing PSA levels.
Puppo
Paolo
P
Urology Unit, Department of Surgical Oncology, National Institute for Cancer Research, Genoa, Italy.
Introini
Carlo
C
Calvi
Paolo
P
Naselli
Angelo
A
D000368:Aged; D001706:Biopsy; D003937:Diagnosis, Differential; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D020728:Transurethral Resection of Prostate; D016896:Treatment Outcome