Long-term clinical outcome of diagnostic transurethral resection of the prostate in patients with elevated prostate-specific antigen level and minor lower urinary tract symptoms.
BACKGROUND
In patients with minor lower urinary tract symptoms (LUTS), elevated prostate-specific antigen (PSA) levels and (multiple) negative multi-site biopsies, therapy decision is complex. Long-term outcome of a diagnostic transurethral resection of the prostate (TURP) in these patients needs to be determined.


METHODS
We retrospectively evaluated patients with minor LUTS, elevated PSA levels (>or=4 ng/ml) and no signs of prostate cancer. Patients with bladder outlet obstruction (BOO) underwent TURP. When TURP showed no malignancy, patients were annually evaluated by PSA testing and the International Prostate Symptom Score (IPSS).


RESULTS
The study included 82 consecutive patients satisfying the inclusion criteria. All patients underwent TURP. No malignancy was encountered in 74 patients (90.2%). Of this group, 36 patients were followed >3 years (mean 62.1 months). One patient (2.8%) showed a persistently rising PSA level with positive extended multi-site biopsies 4 years after TURP, implying further treatment. 35 patients (97.2%) had a permanent complete normalization of PSA levels (<4 ng/ml) together with normalized IPSS.


CONCLUSIONS
We consider an elevated PSA level in patients with minor LUTS and (multiple) negative multi-site biopsies as a sign of BOO. If these patients receive a diagnostic TURP, long-term outcome is excellent.
van Renterghem
Koenraad
K
Department of Urology, Virga Jesse Hospital, Hasselt, Belgium.
van Koeveringe
Gommert
G
Achten
Ruth
R
van Kerrebroeck
Philip
P
D000368:Aged; D001707:Biopsy, Needle; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D020728:Transurethral Resection of Prostate; D001748:Urinary Bladder Neck Obstruction / Q000209:etiology*
D017430:Prostate-Specific Antigen