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Inzidentelles Prostatakarzinom: Kann und soll die radikale Prostatektomie danach empfohlen werden?

Incidental carcinoma of the prostate: can we and should we recommend radical prostatectomy?

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Zusammenfassung

Hintergrund

Das inzidentell durch die transurethrale Resektion der Prostata (TURP) entdeckte Prostatakarzinom (PC) wird bezüglich der Tumorkontrolle kontrovers beurteilt. Wir evaluierten an einem großen Patientenkollektiv, ob die radikale Prostatektomie (RP) nach TURP empfohlen werden kann.

Material and Methode:

Von 1207 Patienten zur RP wurde bei n=52 (4,3%) die Diagnose durch die TURP gestellt. In einer retrospektiven Analyse haben wir die Morbidität, das histopathologische Ergebnis und die Tumorkontrolle des T1a/b-Karzinoms analysiert.

Ergebnisse

Die Anzahl der inzidentellen PC nahm über die Jahre ab. In 5,8% bei inzidentellem PC und 0,5% nach Biopsie war kein residueller Tumor nachweisbar (p<0,001). Die Morbidität war vergleichbar ±TURP mit Ausnahme der Operationszeit (206 vs. 188 min) und Katheterverweildauer (19,3 vs. 17,3 Tage). Das Ergebnis bezüglich Kontinenz war identisch. Die Tumorkontrolle ergab keine Unterschiede für Lokalrezidive und PSA-freies Überleben.

Schlussfolgerung

Das inzidentelle PC nimmt über die Jahre ab, es handelt sich aber in >90% um einen klinisch relevanten Tumor. Die TURP vor einer RP ist kein ungünstiger prognostischer Faktor und die Morbidität ist vergleichbar mit Patienten, die durch die Nadelbiopsie diagnostiziert wurden. Unsere Daten legen die Schlussfolgerung nahe, dass man Patienten mit inzidentellem PC die RP uneingeschränkt empfehlen sollte, sofern die Patienten Kandidaten für eine kurative Therapie darstellen.

Abstract

Introduction

There is controversy regarding tumor control of incidental prostate cancer (PC). We evaluated in a large cohort if we can recommend radical prostatectomy after TURP.

Material and method

In 52 (4.3%) from a total of 1207 patients undergoing radical prostatectomy the diagnosis had been made by TURP. In a retrospective analysis we evaluated morbidity, histopathological results, and tumor control of pT1a/b tumors.

Results

The number of incidentally detected PC decreased with time. In 5.8% in the TURP group and in 0.5% of the needle biopsy group, there was no residual tumor found (p<0.001). Morbidity was similar ± TURP with the exception of operation time (206 vs 188 min) and catheter duration (19.3 vs 17.3 days). Postoperative continence was identical. There was no difference in tumor control for local recurrence-free survival and PSA-free survival with and without TURP.

Conclusions

The rate of incidentally detected PC by TURP decreases over time, but in almost all cases we found clinically relevant cancer. TURP is not an adverse prognostic factor and morbidity is similar compared with patients who were diagnosed by needle biopsy. Our data confirm that we should recommend radical prostatectomy to patients who are candidates for further curative therapy.

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Authors and Affiliations

  1. Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität, München

    R. Paul, C. Knebel, H. van Randenborgh, H. Kübler, M. Alschibaja, M. Günther & R. Hartung

  2. Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität, Ismaninger Straße 22, 81675, München

    R. Paul

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  1. R. Paul
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  2. C. Knebel
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  3. H. van Randenborgh
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  4. H. Kübler
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  5. M. Alschibaja
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  6. M. Günther
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  7. R. Hartung
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Correspondence to R. Paul.

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Paul, R., Knebel, C., van Randenborgh, H. et al. Inzidentelles Prostatakarzinom: Kann und soll die radikale Prostatektomie danach empfohlen werden?. Urologe 44, 1052–1058 (2005). https://doi.org/10.1007/s00120-005-0859-8

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  • DOI: https://doi.org/10.1007/s00120-005-0859-8

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