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Transurethral resection of the prostate for patients with Gleason score 6 prostate cancer and symptomatic prostatic enlargement: a risk-adaptive strategy for the era of active surveillance

 Kyo Chul Koo  ;  Sang Un Park  ;  Koon Ho Rha  ;  Sung Joon Hong  ;  Seung Choul Yang  ;  Chang Hee Hong  ;  Byung Ha Chung 
 Japanese Journal of Clinical Oncology, Vol.45(8) : 785-790, 2015 
Journal Title
 Japanese Journal of Clinical Oncology 
Issue Date
OBJECTIVE: To investigate whether transurethral resection of the prostate can be used as both (i) treatment for symptomatic prostatic enlargement in patients with prostate cancer and (ii) a risk-adaptive strategy for reducing prostate-specific antigen levels and broadening the indications of active surveillance. METHODS: We retrospectively reviewed data of 3680 patients who underwent prostate biopsies at a single institution (March 2006 to January 2012). Of 529 men who had Gleason score 6 prostate cancer and were ineligible for active surveillance, 86 (16.3%) underwent transurethral resection of the prostate for symptomatic prostatic enlargement. We assessed how changes in prostate-specific antigen and prostate-specific antigen density influenced the eligibility for active surveillance and the outcome of subsequent therapy. The following active surveillance criteria were used: prostate-specific antigen ≤ 10 ng/ml, prostate-specific antigen density ≤ 0.15, positive cores ≤ 3 and single core involvement ≤ 50%. RESULTS: The median age, pre-operative prostate-specific antigen and prostate volume were 71 years, 6.95 ng/ml, and 45.8 g, respectively. In 82.6% (71/86) of analyzed cases, ineligibility for active surveillance had resulted from elevated prostate-specific antigen level or prostate-specific antigen density. With a median resection of 16.5 g, transurethral resection of the prostate reduced the percentage of prostate-specific antigen and the percentage of prostate-specific antigen density by 34.5 and 50.0%, respectively, making 81.7% (58/71) of the patients eligible for active surveillance. Prostate-specific antigen level remained stabilized in all (21/21) patients maintained on active surveillance without disease progression during the median follow-up of 50.6 months. Among patients who underwent radical prostatectomy, 96.7% (29/30) exhibited localized disease. CONCLUSIONS: Risk-adaptive transurethral resection of the prostate may prevent overtreatment and allay prostate-specific antigen-associated anxiety in patients with biopsy-proven low-grade prostate cancer and elevated prostate-specific antigen. Additional benefits include voiding symptom improvement and the avoidance of curative therapy's immediate side effects.
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실)
Yonsei Authors
구교철(Koo, Kyo Chul) ORCID logo https://orcid.org/0000-0001-7303-6256
나군호(Rha, Koon Ho)
박상언(Park, Sang Un)
양승철(Yang, Seung Choul)
정병하(Chung, Byung Ha) ORCID logo https://orcid.org/0000-0001-9817-3660
홍성준(Hong, Sung Joon) ORCID logo https://orcid.org/0000-0001-9869-065X
홍창희(Hong, Chang Hee)
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