TURPTURP

as diagnostic measure of as diagnostic measure of Prostate CancerProstate Cancer

Oral presentation at the Meeting of Okinawa Urologists (Naha-city, Japan, 2004)004)

Vladimir Startsev,Vladimir Startsev, M.D., Urology Department, Regional Oncological Hospital

St.-Petersburg, Russia

PurposePurpose

To determine whether evaluation of TURP To determine whether evaluation of TURP

could detect could detect prostate cancer prostate cancer

missed by routine missed by routine

US-GuidedUS-Guided sextant prostate biopsiessextant prostate biopsies

9898 patientspatients (median age 66,4 y.o.)

with LUTS with LUTS andand

tPSA tPSA levellevel 5-12 5-12 ng/mL

All persons underwent systematic

US-guided sextant

PZ - biopsiesPZ - biopsies

Our post-biopsy resultsOur post-biopsy results

Positive (+) specimensPositive (+) specimens

28 28 cases of

prostate cancer

Negative (-) Negative (-) specimensspecimens

　 　 70 70 cases

28.6%28.6% 71.4%71.4%

TURP to all patientsTURP to all patients

with with negative (-) specimens negative (-) specimens andand indications to relief indications to relief LUTS LUTS && BNO BNO (n=49)(n=49)

Prostate cancer

in 12 (24.5%)in 12 (24.5%) - organ-confined

- Gleason score < 5

- <10 % of resected tissue

4 - RRP,

8 – MAB (Zoladex+Androcur) +RBT

Follow-up 6 month Follow-up 6 month

of non - operated, of non - operated,

(-) specimens patients (-) specimens patients (n=21)(n=21)

tPSAtPSA level increase in 77 (33.3%33.3%) cases, 7 second US-G biopsies

Prostate Cancer in 4 (19.0%) cases( 4 RRP performed)

Summarized schemaSummarized schema98 US-Guided biopsies

28.6% 71.4%

TURP n=49 Medicine n=21

24.5%24.5%19.0%19.0%

1212

44

DiscussionDiscussion

Specificity of routine US-guided prostate Specificity of routine US-guided prostate

biopsy is not high enough, using this biopsy is not high enough, using this

procedure is not warranted for cancer procedure is not warranted for cancer

detection.detection.

DiscussionDiscussion

TURP can detect cancer also in TZ of the TURP can detect cancer also in TZ of the

prostate, while treating LUTS with BNO prostate, while treating LUTS with BNO

in patients with negative biopsy in patients with negative biopsy

specimens.specimens.

ConclusionConclusionss

TURP is necessary for TURP is necessary for all patients with all patients with

severe LUTS (BNO associated) severe LUTS (BNO associated)

and negative prostate biopsies.and negative prostate biopsies.

ConclusionConclusionss

Now we perform Now we perform octant (n=8 cores)octant (n=8 cores)

US-Guided prostate biopsies.US-Guided prostate biopsies.

Do all we must?Do all we must?

Thank you for attention!Thank you for attention!

St.-Petersburg, Russia, 2004

Vladimir Startsevhttp://www.urostar.ru