Safety And Efficacy Of Combined Transrectal Ultrasound-Guided Prostate Needle Biopsy And Transurethral Resection Of The Prostate

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 02 Aug 2010 - 11:00 PDT


UroToday.com - This study was conducted to examine whether simultaneous transrectal prostate needle biopsy (TPNB) due to an increase in PSA levels is safe and effective in patients who are scheduled for transurethral resection of the prostate (TURP) for benign prostate hyperplasia (BPH).

Combined TPNB and TURP was performed in a total of 42 patients aged >= 60 years who had gray zone PSA (4-10 ng/ml) and PSA density (PSAD) values of <= 0.12. The frequencies of fever, sepsis and epididymitis were assessed after surgery. The diagnostic accuracy was assessed, and the results of histologic examination were evaluated in terms of TPNB or TURP. In addition, the diagnostic accuracy was assessed according to age.

Six (14.3%) of the 42 patients were diagnosed with prostate cancer: 2 patients were diagnosed with prostate cancer by only TPNB, 3 patients by only TURP and 1 patient by combined TPNB and TURP. Four (25%) of the 16 patients aged < 70 years and 2 (7.8%) of the 26 patients age ≥70 years were diagnosed with prostate cancer. Fever was observed in 9 patients (21.4%), 4 (9.5%) of whom had a fever of ≥ 38. The fever normalized the day after surgery in all 9 patients. No septicemia was noted. There were no serious complications related to combined TPNB and TURP.

The results of this study have some limitations. First, it was a retrospective in nature and the number of subjects was relatively small. Second, even TURP can enhance the diagnostic yield of prostate cancer in this group of patients, but at the same time it could miss some chance of radical prostatectomy without prior TURP. However, we confirmed that combined TPNB and TURP may be safe and that the possibility of prostate cancer may be reduced in elderly patients as found in previous studies.

Since combined TPNB and TURP is a safe procedure, it should be performed on patients who need the 2 procedures. In particular, this combined procedure may be useful for patients with prior TPNB-negative results who need TURP. And, since there is a low possibility of prostate cancer in BPH patients with a PSAD value of < 0.12 and greater than 70 years old, combined TPNB and TURP can prevent unnecessary TPNB prior to TURP.

Written by Tag Keun Yoo, MD, PhD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract.

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