Survival after incidental prostate cancer diagnosis at transurethral resection of prostate: 10-year outcomes

• Published in: Irish journal of medical science 2012-03, Vol.181 (1), p.27-31
• Main Authors: Ahmad, S., O’Kelly, F., Manecksha, R. P., Cullen, I. M., Flynn, R. J., McDermott, T. E. D., Grainger, R., Thornhill, J. A.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal - therapeutic use; Family Medicine; General Practice; Humans; Incidental Findings; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Prostatectomy; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - pathology; Prostatic Neoplasms - therapy; Prostatism - surgery; Radiotherapy; Survival Analysis; Watchful Waiting
• ISSN: 0021-1265; 1863-4362
• DOI: 10.1007/s11845-011-0753-x

Background The most appropriate management of incidental prostate cancers diagnosed at transurethral resection of prostate has been debated. It is important to determine the long-term outcomes to establish an appropriate management in patients with incidental prostate cancer. Aims We aim to determine 10-year survival and to identify the factors of worse prognosis of incidental prostate cancers diagnosed at transurethral resection of prostate. Methods A retrospective analysis of patients with pT1a–pT1b prostate cancers diagnosed between 1998 and 2003. Medical notes, PSA and pathology results were reviewed. Overall and cancer specific survival was calculated at mean 10-year follow-up. Results Sixty patients with incidental prostate cancer were identified (pT1a = 18, pT1b = 42). Fifty-one percents of the patients were managed on a watchful waiting strategy with overall 84% survival and 9.7% cancer specific mortality. Twenty patients (all with pT1b) received hormone therapy. Overall survival in this cohort was 50% with 20% cancer specific mortality. Nine patients received curative therapy (Radical prostatectomy = 4, Radiotherapy = 5). In this group, overall survival was 88% with no cancer specific mortality. Conclusions Stage pT1a disease and preoperative low PSA were associated with favourable survival. However, for pT1b and/or high Gleason score (≥7), mortality was comparatively higher. Hence, patients with high Gleason score and/or pT1b disease should be considered for curative therapy. Additionally, active surveillance may have a role in selected men with incidental prostate cancer.