title: Transurethral resection of the prostate for patients with Gleason score 6 prostate cancer and symptomatic prostatic enlargement: a risk-adaptive strategy for the era of active surveillance.
abstract: OBJECTIVE
  To investigate whether transurethral resection of the prostate can be used as both (i) treatment for symptomatic prostatic enlargement in patients with prostate cancer and (ii) a risk-adaptive strategy for reducing prostate-specific antigen levels and broadening the indications of active surveillance.
  
  
  METHODS
  We retrospectively reviewed data of 3680 patients who underwent prostate biopsies at a single institution (March 2006 to January 2012). Of 529 men who had Gleason score 6 prostate cancer and were ineligible for active surveillance, 86 (16.3%) underwent transurethral resection of the prostate for symptomatic prostatic enlargement. We assessed how changes in prostate-specific antigen and prostate-specific antigen density influenced the eligibility for active surveillance and the outcome of subsequent therapy. The following active surveillance criteria were used: prostate-specific antigen ≤ 10 ng/ml, prostate-specific antigen density ≤ 0.15, positive cores ≤ 3 and single core involvement ≤ 50%.
  
  
  RESULTS
  The median age, pre-operative prostate-specific antigen and prostate volume were 71 years, 6.95 ng/ml, and 45.8 g, respectively. In 82.6% (71/86) of analyzed cases, ineligibility for active surveillance had resulted from elevated prostate-specific antigen level or prostate-specific antigen density. With a median resection of 16.5 g, transurethral resection of the prostate reduced the percentage of prostate-specific antigen and the percentage of prostate-specific antigen density by 34.5 and 50.0%, respectively, making 81.7% (58/71) of the patients eligible for active surveillance. Prostate-specific antigen level remained stabilized in all (21/21) patients maintained on active surveillance without disease progression during the median follow-up of 50.6 months. Among patients who underwent radical prostatectomy, 96.7% (29/30) exhibited localized disease.
  
  
  CONCLUSIONS
  Risk-adaptive transurethral resection of the prostate may prevent overtreatment and allay prostate-specific antigen-associated anxiety in patients with biopsy-proven low-grade prostate cancer and elevated prostate-specific antigen. Additional benefits include voiding symptom improvement and the avoidance of curative therapy's immediate side effects.
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyo Chul
authors.initials: KC
authors.lastname: Koo
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sang Un
authors.initials: SU
authors.lastname: Park
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Koon Ho
authors.initials: KH
authors.lastname: Rha
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sung Joon
authors.initials: SJ
authors.lastname: Hong
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Seung Choul
authors.initials: SC
authors.lastname: Yang
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Chang Hee
authors.initials: CH
authors.lastname: Hong
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea chung646@yuhs.ac.
authors.forename: Byung Ha
authors.initials: BH
authors.lastname: Chung
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011159:Population Surveillance / Q000379:methods; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020728:Transurethral Resection of Prostate
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen
keywords: prostate cancer; prostate-specific antigen; surveillance; transurethral resection of prostate