Urology and Andrology

Inicidental prostate cancer: prediction of tumour progression

The objective. Creation of convenient and easy-to-use prognostic system permitting to predict progression of IPC and thus determine the need for active treatment in patients with IPC or a possibility of active observation.

Patients and methods. In patients with benign prostatic hyperplasia (BPH) and incidental prostate cancer (IPC) we compared clinical and morphological parameters and determined their intercorrelation.

Results. The mean arithmetic values of age and prostate volume were reliably higher in the IPC group, though the difference was insignificant. In the IPC group, the levels of total prostate-specific antigen (tPSA) and prostate-specific antigen density (PSAd) were practically two times higher. Urination parameters had the worst values in the IPC group. Chronic inflammation is found equally frequently in both groups. High grade prostatic intraepithelial neoplasia (HG PIN) was more often diagnosed in the IPC group, and low grade prostatic intraepithelial neoplasia (LG PIN) is more often found in the BPH group. The strongest correlations in the BPH group were demonstrated by the relations between prostate volume and tPSA and PSAd levels (r – 0.45 and r – 0.47), and also PSA and HG PIN levels (r – 0.42). In patients with IPC, practically all correlations characteristic for the group were absent. This specificity might be partially related to a small volume of the sample. Nevertheless, according to our findings, in patients with IPC there is no relationship between prostate volume, age, values of PSA, etc. Among all studied parameters, only two reliable (p < 0.05) correlations were noted: prostate volume and LG PIN (r – 0.345, p =0.02) and chronic inflammation and HG PIN (r – 0.414, p = 0.005). For predicting the progression of IPC we created a multi-factor prognostic model based on analysis of two parameters, tPSA levels before operative intervention and a sum of Gleason scores obtained at morphological examination after TUR. This model has a high prognostic value (area under curve 86.6%) and might be easily used in practice. Also, this system does not depend on the stage of the process T1a or T1b. For interpretation of calculated results we created a special chart permitting to access the risk for progression for the next 3.5 years. 

Conclusion. Threshold values of tPSA and sums of Gleason scores for decision making about operative treatment are tPSA >20 ng/ml and Gleason >6. In case of excess values of any of these parameters, the patient should be recommended for operative treatment in the near future after diagnosing IPC, since he will be undoubtedly referred to the group of moderate risk for progression.

Key words: incidental prostate cancer, prostate cancer, T1a, T1b transurethral resection of prostatic hyperplasia.

Publisher's imprint: Urology and Andrology, 2016, volume 4, No 1, p. 12–18. The article was received 26.10.2015.

DOI: 10.20953/2307-6631-2016-1-12-18