title: Prospective study of the role of transurethral resection of the prostate in patients with an elevated prostate-specific antigen level, minor lower urinary tract symptoms, and proven bladder outlet obstruction.
abstract: BACKGROUND
  Deciding on strategy for patients with minor lower urinary tract symptoms (LUTS), elevated prostate-specific antigen (PSA) levels, unsuspicious digital rectal examination (DRE) and/or transrectal ultrasound (TRUS), and multiple negative extended prostate biopsies is complex.
  
  
  OBJECTIVE
  To define the role and clinical significance of transurethral resection of the prostate (TURP) in these patients.
  
  
  METHODS
  Thirty-three patients with elevated PSA; minor LUTS, as assessed by the International Prostate Symptoms Score (IPSS); no suspicion for prostate cancer on DRE and/or TRUS; and negative extended prostate biopsies were prospectively enrolled in a cohort study at a tertiary care institution.
  
  
  METHODS
  After full urodynamic investigation showing all patients to be bladder outlet obstructed, TURP was performed.
  
  
  METHODS
  Resected tissue was histologically examined for presence of prostate cancer. Within 6 mo after TURP, patients were clinically reevaluated by means of IPSS and PSA level.
  
  
  CONCLUSIONS
  Preoperatively, mean PSA and IPSS values were 8.2ng/ml and 6.8, respectively. Mean detrusor pressure at maximum flow was 80.3cm H(2)O. Histological examination after TURP revealed benign prostate hyperplasia in 81.8% (subgroup 1) and aggressive prostate cancer in 6.1% of patients (subgroup 2). In 12.1% of patients, only a few chips of nonaggressive prostate cancer (T1a) were detected. In patients without signs of aggressive prostate cancer (93.9%=12.1%+81.8%, subgroup 3), mean postoperative PSA and IPSS values were 0.6ng/ml and 2.4, respectively, while these values were 0.6ng/ml and 2.5ng/ml in subgroup 1 (p<0.0001). This study is limited in sample size, requiring more research to confirm these results.
  
  
  CONCLUSIONS
  This prospective study shows that, in patients with minor LUTS and no suspicion for prostate cancer, bladder outlet obstruction can result in elevated PSA levels. These patients will benefit from TURP regarding symptomatology and supernormalisation of PSA levels. Moreover, albeit in few cases, histological examination will reveal aggressive prostate cancer.
authors.affiliation: Department of Urology, Virga Jesse Hospital, Hasselt, Belgium. koenraad.van.renterghem@ageingmaleclinic.be
authors.forename: Koenraad
authors.initials: K
authors.lastname: van Renterghem
authors.forename: Gommert
authors.initials: G
authors.lastname: Van Koeveringe
authors.forename: Ruth
authors.initials: R
authors.lastname: Achten
authors.forename: Philip
authors.initials: P
authors.lastname: van Kerrebroeck
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000150:complications / Q000601:surgery; D053448:Prostatism / Q000097:blood* / Q000150:complications / Q000601:surgery*; D020728:Transurethral Resection of Prostate; D001748:Urinary Bladder Neck Obstruction / Q000097:blood* / Q000150:complications / Q000601:surgery*
chemical_list: D017430:Prostate-Specific Antigen