T1a/T1b transitional zone prostate cancer detection rates in patients who had TURP for clinically diagnosed benign prostatic enlargement in Southern Nigeria
DOI:
https://doi.org/10.47672/ejhs.995Keywords:
Incidental cancer, prostate cancer, transitional zone, T1a, T1b, TURPAbstract
Background: Transurethral resection of the prostate (TURP) removes the obstructing adenoma that grows from the transitional zone of the prostate. Resected chips are routinely sent for histologic examination. Incidental findings of prostate cancer in the TURP specimen for the clinically diagnosed benign disease may occur. The American Joint Committee on Cancer (AJCC) TNM staging of prostate cancer allocates T1a if <5% of the resected chips are malignant and T1b if >5% are malignant.
Aim: To determine the frequency of incidental prostate cancer rate in TURP specimens of patients who had the procedure for clinically diagnosed benign prostatic enlargement.
Methodology: This was a retrospective study carried out over a period of 8years from January 2013 to December 2020 on patients who had TURP for clinically diagnosed BPE or biopsy diagnosed BPH. All the patients had TURP for benign enlargements of the prostate. The resected prostate chips were sent for histopathological analysis. Patients with incomplete data and patients who had transrectal peripheral zone prostate biopsy confirmed cancers before TURP were excluded from this study. The data was collated using Microsoft Excel version 2020 and was analyzed using SPSS version 20.
Results: There were 220 male patients with a mean age was 65.89 ±9.95years, and median age was 65years. The 60-69years group had the highest incidence of PCa. The T1a/T1b adenocarcinoma detection rate was 13.6% (30). 54.6% (120) had BPH only, and 31.8% (70) had BPH with prostatitis. All incidentally diagnosed T1a/T1b cancers were adenocarcinomas. The majority of the T1a/T1b adenocarcinomas, 43.3% (13), were poorly differentiated, while 36.7% (11) and 20% (6) had well and moderate differentiation, respectively.
Conclusion: The Incidental T1a/T1b transitional zone adenocarcinoma detection rate in TURP specimens in the study was 13.6%. The high Gleason’s grade adenocarcinoma was the most frequent. Even when perceived as clinically benign, communication of the risk of cancer detection to the patient is pertinent and should be a routine part of the informed consenting process before TURP.
Downloads
References
Hyuna Sung, Jacques Ferlay, Rebecca Siegel, et al.; Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 cancers in 185 countries. 2021
Ekeke O, Amusan O, Eke N. Management of prostate cancer in port Harcourt, Nigeria: changing patterns. J West Afr Coll Surg. 2012;2(3):58-77.
Ajape AA, Babata A, Abiola OO. Knowledge of prostate cancer screening among native African urban population in Nigeria. Nigerian Quarterly Journal of Hospital Medicine. 2009 Jul-Sep;19(3):145-147.
Enemugwem, Rogers A. et al. “Prostate cancer screening: assessment of knowledge and willingness to screen among men in Obio Akpor LGA, Rivers State, Nigeria.” African Journal of Urology.2019; 25: 1-4.
Key T. Risk factors for prostate cancer. Cancer Surv. 1995; 23:63-77.
Obiorah CC, Nwosu SO; A Histopathological study of carcinoma of the prostate in Port Harcourt, Nigeria. Nigerian Journal of clinical practice.2011;14: 363-367
MR Cooperberg, SL Washington III, PR Carroll; Cancer of the Prostate Gland: Smith and Tanagho’s General Urology 19th Edition, pg353, 2020
Ali, A., Du Feu, A., Oliveira, P. et al. Prostate zones and cancer: lost in transition?. Nat Rev Urol 19, 101–115 (2022).
Alhasan SU, Aji SA, Mohammed AZ, Malami S. Transurethral resection of the prostate in Northern Nigeria, problems and prospects. BMC Urology. 20088:18.
Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017;67(2):93-99.
Brandon Otto, Christopher Barbieri, et al.; Incidental Prostate Cancer in Transurethral Resection of the Prostate specimen in modern era. Advances in Urology, vol. 2014. Article ID 627290, 4 pages, 2014.
Janjua TK et al. Incidental finding of prostate cancer in Transurethral Resection of Prostate (TURP) specimens: a retrospective analysis from a Tertiary Care Hospital in Pakistan. Pan African Medical Journal. 2021;39(20). 10.11604/pamj.2021.39.20.26931.
Jones, J., Follis, H. & Johnson, J. Probability of finding T1a and T1b (Incidental) prostate cancer during TURP has decreased in the PSA era. Prostate Cancer Prostatic Dis. 2009; 12:57–60.
Ornstein DK, Rao GS, Smith DS, Andriole GL. The impact of systematic prostate biopsy on prostate cancer incidence in men with symptomatic benign prostatic hyperplasia undergoing transurethral resection of the prostate. J Urol 1997; 157: 880–883.
4 Argyropoulos A, Doumas K, Farmakis A, Aristas O, Kontogeorgos G, Lykourinas M. Characteristics of patients with stage T1b incidental prostate cancer. Scand J Urol Nephrol 2005; 39: 289–293.
Meguro N, Maeda O, Saiki S, et al. Hinyokika Kiyo. 1998;44(9):639-643.
2 Monda JM, Barry MJ, Oesterling JE. Prostate specific antigen cannot distinguish stage T1a (A1) prostate cancer from benign prostatic hyperplasia. J Urol 1994; 151: 1291–1295.
13 Ornstein DK, Rao GS, Smith DS, Andriole GL. The impact of systematic prostate biopsy on prostate cancer incidence in men with symptomatic benign prostatic hyperplasia undergoing transurethral resection of the prostate. J Urol 1997; 157: 880–883.
Robinson D, Aus G, Bak J, et al. Long-term follow-up of conservatively managed incidental carcinoma of the prostate: a multivariate analysis of prognostic factors. Scand J Urol Nephrol. 2007;41(2):103-109.
Abedi AR, Ghiasy S, Fallah-Karkan M, Rahavian A, Allameh F. The Management of Patients Diagnosed with Incidental Prostate Cancer: Narrative Review. Res Rep Urol. 2020;12:105-109.
Smith ZL, Eggener SE, Murphy AB. African-American Prostate Cancer Disparities. Curr Urol Rep. 2017;18(10):81.
Downloads
Published
How to Cite
Issue
Section
License
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution (CC-BY) 4.0 License that allows others to share the work with an acknowledgment of the work’s authorship and initial publication in this journal.
