The Advantages of TURP in Patients with an Elevated/Rising PSA, Mild/Moderate LUTS, Bladder Outlet Obstruction and Negative Prostate Cancer Imaging/Prostate Biopsies. A Prospective Analysis in 105 Consecutive Patients
Journal Title: Open Access Journal of Urology & Nephrology - Year 2016, Vol 1, Issue 1
Abstract
Aim: To investigate elevated/rising PSAas a marker for BOO (Bladder Outlet Obstruction) in patients with minor LUTS (Lower urinary tract Symptoms) and without prostate cancer. Methods: 105 Consecutive patients were prospectively analyzed between 2005 and 2013. All patients were referred to the principal investigator by their general practitioner as a result of an elevated and/or rising PSA. Only patients with minor LUTS (I-PSS (International Prostate Symptom Score) 0-19)) and without suspicion for prostate cancer were included. All patients had BOO, shown by full urodynamics, and underwent TURP. Resected tissue was histologically examined and PSA/IPSS were evaluated after 3, 6 and 12 months and later on yearly. Results: Mean pre-operative PSA- and I-PSS- values were 8.8 ng/mL and 11.1 respectively. The mean detrusor pressure at maximum flow was 93.6 cm H2O. The mean resected volume 52 g and the mean prostatebiopsyrate 1.8. 83/105 patients (79%) had no malignancy and were diagnosed with BOO due to BPH (Benign Prostatic Hyperplasia) (subgroup 1). Their mean PSA decreased from 9.2to 0.7ng/ml and 0.9 ng/ml after 6 and 12 months post-op respectively. The mean IPSS declined from 11 to 3 after 6 months and12months. 16/105 patients (15%) were treated for prostate cancer (subgroup 2). Radical prostatectomy was performed in 11 patients, brachytherapy in 3 patients and external beam radiotherapy in 2 patients. 6/105 Patients (5.7%) had active surveillance (subgroup 3). Conclusion: BOO can cause an elevated/rising PSA in patients with minor LUTS and negative screening for prostate cancer. TURP is an adequate treatment for these patients. Core tip: Patients referred to the urologist because of an elevated/high PSA-value, are a common problem in the daily practice. After excluding prostate cancer or urinary tract infection, patients are reassured. But what has to be done when the PSA-level rises? Our hypothesis suggests that BOO (bladder outlet obstruction) can cause an elevated/high PSA in patients with minor LUTS (I-PSS 0-19) and negative findings for prostate cancer. We describe our findings in 105 consecutive, prospectively enrolled patients and also describe the benefits of a TURP in these patients.
Authors and Affiliations
E. Baten
Keywords
Related Articles
- EP ID EP487063
- DOI 10.23880/oajun-16000105
- Views 88
- Downloads 0
Urodynamic Findings in Patients with Diabetes Mellitus and Lower Urinary Tract Symptoms
Objective: To characterize urodynamic (UDS) findings in North American patients with diabetes mellitus (DM) and lower urinary tract symptoms (LUTS) from a contemporary cohort. Methods: A multi-center UDS database (1997-2...
Paratesticular Masson’s Hemangioma Case Report and Review of the Literature
Masson’s hemangioma or intravascular papillary endothelial hyperplasia is a rare intravascular benign lesion. It may involve a wide variety of organs, most frequently the skin and subcutaneous tissue. Regarding the uroge...
Living Donation by Individuals of African Descent: Should it continue to be Encouraged in Sub- Saharan African Countries?
Kidney transplantation is considered as the treatment of choice for patients with End Stage Renal Disease (ESRD). Studies comparing outcomes of renal replacement therapies have shown that overall survival is much longer...
Urological Presentation in Zika Virus Infection: A Forgotten Issue
Zika virus infection is an important problem at present. The clinical presentation of Zika virus infection is usually mild or asymptomatic but it can also induce the neurological complication and teratogenic problem. In...
Malone Procedure Combined with Mitrofanoff Using a Divided Appendix and Vesical Enlargement Description of the Surgical Technique and Case Report
Surgical treatment for neurogenic bladder has evolved notably. A great number of patients with neurogenic bladder also present fecal incontinence and treatment for these patients is discouraging. With the induction and u...